Surgical Management of Heterotopic Cesarean Scar Pregnancy With Preservation of Intrauterine Pregnancy in the First Trimester.

OBJECTIVE

To demonstrate hysteroscopic selective reduction of a heterotopic cesarean scar pregnancy while preserving a concurrent intrauterine pregnancy.

SETTING

Tertiary Care Center.

PARTICIPANTS

A single case study report of a 41-year-old G3P2001 with two prior cesarean deliveries who underwent two-embryo in vitro fertilization (IVF) transfer and was diagnosed with a heterotopic pregnancy consisting of a fundal intrauterine pregnancy and a cesarean scar pregnancy.

INTERVENTIONS: Under intraoperative ultrasound guidance, a 27F operative bipolar hysteroscope was introduced using normal saline as the distension medium. Intrauterine pressure was maintained at ≤60 mmHg, with a final fluid deficit of 750 mL. Selective hysteroscopic reduction of the cesarean scar pregnancy was performed using a loop bipolar electrode. Complete reduction was confirmed intraoperatively using transverse and sagittal ultrasound imaging.

CONCLUSION

Surgical management using a loop bipolar hysteroscopic system enabled successful selective reduction of the cesarean scar pregnancy while preserving the concurrent intrauterine fundal pregnancy. Hysteroscopic selective reduction may represent a feasible minimally invasive approach for the management of heterotopic cesarean scar pregnancy in cases where preservation of the intrauterine pregnancy is desired.