Case Report

Resection of Cesarean Scar Pregnancy at Six Weeks of Gestation with Laminaria Cervical Dilatation under Sonographic and Hysteroscopic Guidance

Table 1

Primary hysteroscopic resection of fetal heartbeat-positive cesarean scar pregnancy cases that appeared in journals containing hysteroscopic color figures.

CaseAuthors, journal or congress, yearAge (y) gravity and parity previous CS ()Mode of conceptionBleedingGestation (weeks and days or weeks)FHBSize of GS, CRLDiagnostic modalities (TVUS, TAUS, and MRI)Preoperative beta-hCG level (mIU/mL)Implantation siteCervical dilatation (Laminaria or Hegar)ManagementTAUS guidance or laparoscopic assistRemarks

1 Hoshino T et al., 
ISUOG, 
2014
29
G2P1
1
SpontaneousNo6 w 1 d+GS: 18.7 mmTVUS, TAUS21,235Anterior wall, fundal sideLaminariaHysteroscopic resectionTAUS

2Chang et al.,
Fertil Steril,
2011 [5]
29
G3P2
2
Not documentedVaginal bleeding7 weeks+GS: 21 mm
CRL: 8.1 mm
TVUS 51,775Anterior wall, right fundal sideHegar dilatation to 11 mmDiluted vasopressin injection, resection with wire loop electrodeNot documented

3Wang et al.,
Fertil Steril,
2010 [3]
31
G3P1
1
IVF, 4 embryos transferredVaginal bleeding7 weeks+GS: +
CRL: +
TVUS, TAUS99,544Not documentedHegar dilatation to 11 mmHysteroscopic-directed evacuation and D&CUnder US controlHeterotopic CSP. CS at 39 weeks, live male 3250 g

4Robinson et al.,
Fertil Steril,
2009 [6]
44
G6P2
2
SpontaneousNo5 w 6 d+GS: 7.5 mm
CRL: 1.3 mm
Follow-up ultrasound11,082Anterior wall, fundal side Not needed Laparoscope-assisted hysteroscopyLaparoscopy assist

5Deans and Abbott,
Fertil Steril,
2010 [7]
41
Not documented
1
Not documentedNot documented7 weeks+Not documentedNot documented78,000Not documentedNot documentedHysteroscopyNot documented

6Wang et al.,
BJOG,
2005 [4]
36
G5P2
2
SpontaneousNot documented7 w 3 d+Not documentedTVUS28,338Anterior wallHegar dilatation to 12 mmOperative hysteroscopy accompanied by suction curettageNot documented 

Note: y: years old; CS: cesarean section; : number; hCG: human chorionic gonadotropin; FHB: fetal heartbeat; GS: gestational sac; CRL: crown-rump length; TVUS: transvaginal ultrasound; TAUS: transabdominal ultrasound; MRI: magnetic resonance imaging; G: gravidity; P: parity; D&C: dilatation and curettage; CSP: cesarean scar pregnancy.