Outcomes of local vasopressin injection and vaginal evacuation for cesarean scar pregnancy: A retrospective review of 11 cases

Abstract

Aim

Vaginal removal of cesarean scar pregnancy (CSP) carries the risk of massive bleeding and residual gestational tissue. To address these complications, we administered local injections of diluted vasopressin surrounding the gestational tissue before vaginal evacuation. In this study, we investigated the surgical and subsequent reproductive outcomes of patients with CSP treated using this technique.

Methods

We retrospectively analyzed 11 patients between January 2014 and December 2023, for whom the above technique was used to manage cases in which gestational tissue did not bulge on the bladder side. We injected 5–10 mL of vasopressin diluted 100 times with saline surrounding the gestational sac under transvaginal ultrasound guidance and performed vaginal evacuation either electronically or manually.

Results

The median (range) age, body mass index, and gestational week at surgery were 35 (27–43) years, 26.0 (21.5–33.0) kg/m², and 6 (5–8) weeks of gestation, respectively. The longest diameter of the gestational sac was 9.7 (6.5–19.4) mm, and serum human chorionic gonadotropin level at vaginal evacuation was 6327 (1284–14 446) mIU/mL. Surgeries were completed in 17 (10–18) min with minimal blood loss and no residual tissue. Five of the 10 patients who wished for a subsequent pregnancy conceived successfully, and three patients had term deliveries. One patient with a T-shaped uterine cavity experienced recurrent CSP.

Conclusion

Local injection of diluted vasopressin and vaginal evacuation is safe and easy without critical adverse events in patients with CSP, where the gestational tissue is not bulging toward the bladder.