Authors / metadata

  • Authors: Adel Sedrati (1)

  • Affiliation: 1: Ob Gyn private partitionier Tunesia

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DOI: 10.36205/trocarvid5.24002

Per-Hysteroscopic KCL intra-cardiac embryo-injection and management for Cesarean scare pregnancy
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Abstract

The incidence of Cesarean scare pregnancy (CSP) is rising worldwide, due to the increased number of cesarean sections. This case report is about hysteroscopic management of cesarean scare pregnancy. Where an ectopic embryo intracardiac KCL injection was performed under direct vision by using a 05 mm standard hysteroscope. A second time management, always by hysteroscopy. After a follow up and the vanishment of the trophoblastic signal doppler.

There are many protocols proposed to manage CSP. however, there is no standardized treatment due to the lack of consensus in the medical community. Managing some CSP by hysteroscopy could be a less mini-invasive option. Especially, when it is possible to trigger a decreased trophoblastic signal Doppler, under a direct visual intracardiac KCL injection. This will prepare for a safe evacuation of the remaining trophoblastic tissue from the inside of the isthmocele.

In conclusion hysteroscopic KCL intra cardiac embryo injection for CSP, under direct visualizationrealized as shown in this case report could be the base to understand better this ectopic pregnancy, and to get the less invasive option which can be developed.

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References

  • 1. Jordans IPM, Verberkt C, De Leeuw RA, Bilardo CM, Van Den Bosch T, Bourne T, Brölmann HAM, Dueholm M, Hehenkamp WJK, Jastrow N, Jurkovic D, Kaelin Agten A, Mashiach R, Naji O, Pajkrt E, Timmerman D, Vikhareva O, Van Der Voet LF, Huirne JAF. Definition and sonographic reporting system for Cesarean scar pregnancy in early gestation: modified Delphi method. Ultrasound Obstet Gynecol. 2022 Apr;59(4):437-449. doi: 10.1002/uog.24815. PMID: 34779085; PMCID: PMC9322566.
  • 2. ESHRE working group on Ectopic Pregnancy; Kirk E, Ankum P, Jakab A, Le Clef N, Ludwin A, Small R, Tellum T, Töyli M, Van den Bosch T, Jurkovic D. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open. 2020 Dec 16;2020(4):hoaa055. doi: 10.1093/hropen/hoaa055. PMID: 33354626; PMCID: PMC7738750.
  • 3. Verberkt C, Jordans IPM, van den Bosch T, Timmerman D, Bourne T, de Leeuw RA, Huirne JAF. How to perform standardized sonographic examination of Cesarean scar pregnancy in the first trimester. Ultrasound Obstet Gynecol. 2024 Feb 3. doi: 10.1002/uog.27604. Epub ahead of print. PMID: 38308856.
  • 4. Silva B, Viana Pinto P, Costa MA. Cesarean Scar Pregnancy: A systematic review on expectant management. Eur J Obstet Gynecol Reprod Biol. 2023 Sep;288:36-43. doi: 10.1016/j.ejogrb.2023.06.030. Epub 2023 Jul 1. PMID: 37421745.
  • 5. Diakosavvas M, Kathopoulis N, Angelou K, Chatzipapas I, Zacharakis D, Kypriotis K, Grigoriadis T, Protopapas A. Hysteroscopic treatment of Cesarean Scar Pregnancy: A systematic review. Eur J Obstet Gynecol Reprod Biol. 2022 Mar;270:42-49. doi: 10.1016/j.ejogrb.2021.12.038. Epub 2022 Jan 5. PMID: 35016136.
  • 6. Sedrati A, Alonso L, Carugno J. Honeycomb Decidual Pattern of the Endometrium in a Patient with Cesarean Section Scar Ectopic Pregnancy: An Unusual Presentation of a Physiologic Process. J Minim Invasive Gynecol. 2021 Feb;28(2):158-159. doi: 10.1016/j.jmig.2020.04.036. Epub 2020 May 5. PMID: 32380240.