Surgical Management of Heterotopic Cesarean Scar Ectopic with Preservation of Intrauterine Pregnancy in the First Trimester

Study Objective

To demonstrate successful management of heterotopic cesarean scar ectopic with hysteroscopy while preserving intrauterine pregnancy.

Design

Single case study report demonstrating stepwise hysteroscopic technique to manage heterotopic cesarean ectopic pregnancy with narrated footage while preserving intrauterine pregnancy. Our patient was periodically followed throughout her entire pregnancy until delivery of a healthy female infant at 37 weeks.

Setting

Operating room in a community based hospital system

Patients or Participants

Single case study of one patient that was periodically followed throughout her entire pregnancy until delivery via uncomplicated repeat cesarean section at 37 weeks.

Interventions

Bipolar loop hysteroscopy under intraoperative ultrasound guidance to resect heterotopic pregnancy.

Measurements and Primary Results

Successful reduction of a heterotopic pregnancy using hysteroscopy while preserving intrauterine pregnancy. Intrauterine pregnancy resulted in delivery of a healthy female infant at 37 weeks.

Conclusion

This case report presents a single case of a 41-year-old G3P2001 with a history of two prior cesarean sections who had a two embryo IVF transfer that resulted in a fundal intrauterine pregnancy and ectopic cesarean scar pregnancy. Surgical management with a loop bipolar hysteroscopic system under intraoperative ultrasound guidance resulted in successful reduction of the ectopic pregnancy and preservation of the concurrent intrauterine fundal pregnancy. She was periodically followed throughout her pregnancy and had an uncomplicated repeat cesarean section at 37 weeks. Our study suggests that hysteroscopy is a viable technique to manage heterotopic pregnancy for patients who strongly desire to preserve an intrauterine pregnancy.