Combined medical and minimally invasive robotic surgical approach to the treatment and repair of cesarean scar pregnancies

Abstract

Background and Objectives: The rise in cesarean deliv-eries, has led to increase in maternal complications in subsequent pregnancies such as abnormal placental im-plantation, uterine rupture, hemorrhage and, less com-monly, cesarean scar pregnancies (CSP). Our objective was to describe patient characteristics following a combined medical and surgical treatment approach to first trimester cesarean scar pregnancies. Methods: This was a case series approved by the Institutional Review Board of cesarean scar pregnancies over a two-year period at a single academic institution. The study included five patients with diagnosed cesarean scar pregnancies opting for pregnancy termination with the desire for fertility preservation. Medical treatment involved intra-gestational sac injection of lidocaine fol-lowed by systemic injection of methotrexate. At a mini-mum of two months later, surgical resection of cesarean scar pregnancy and repair of the uterus was performed. Results: Median patient age was 36 (range 34 – 42) years, with 4 (3 – 10) prior pregnancies and 2 (1 – 3) prior cesarean deliveries. 40% (2/5) were Hispanic, 20% (1/5) Caucasian, 20% (1/5) African-American, and 20% (1/5) South Asian. After medical intervention, patients waited on average 4.6 ± 2.3 months before surgery. No post-intervention complications or recurrences occurred. Two patients had a subsequent pregnancy. Conclusion: This case series demonstrates an ideal management of cesarean scar pregnancy using combined medical and surgical approach in treating current ectopic pregnancy and repairing the uterine defect successfully without recurrence.