| Autor: |
Wang, C, Koythong, T, Thigpen, B |
| Zdroj: |
Journal of Minimally Invasive Gynecology; 2024 Supplement, Vol. 31 Issue 11, pS60-S60, 1p |
| Abstrakt: |
To demonstrate a stepwise approach of laparoscopic hysterectomy when indicated for treatment of cesarean scar ectopic pregnancy. Stepwise demonstration with narrated video footage. An academic tertiary care hospital. 43-year-old G8P4034 with history of four prior cesarean deliveries, two prior dilation and curettages at 13w0d by LMP who had an unplanned pregnancy. She opted for an elective medical termination with failure of medical therapy. Further evaluation demonstrated concern for cesarean scar ectopic pregnancy based on ultrasound, which was confirmed on MRI pelvis. She was counseled on management options including laparoscopic resection of her ectopic with repair of uterine defect or laparoscopic hysterectomy. The patient expressed satisfied parity and opted for laparoscopic hysterectomy. The patient underwent total laparoscopic hysterectomy, bilateral salpingectomy, lysis of adhesions, bilateral ureterolysis, and cystoscopy. Steps unique to treatment for cesarean scar pregnancy that differ from laparoscopic hysterectomy for other indications include: 1. Ligation of uterine arteries at the origin with hemoclips and transection of utero-ovarian ligaments prior to placement of uterine manipulator 2. Use of Briesky retractor in anterior fornix for bladder flap dissection before the manipulator is placed 3. Injection of vasopressin into cervical stroma prior to manipulator placement Successful management of cesarean scar ectopic pregnancy was performed via laparoscopic hysterectomy. Estimated blood loss was 150 cc and her postoperative course was uncomplicated. Cesarean scar ectopic pregnancies are increasing in prevalence and are associated with higher risk of maternal morbidity due to risk of hemorrhage. When performing laparoscopic hysterectomy for treatment of cesarean scar ectopic pregnancy, various techniques may be employed to minimize blood loss. [ABSTRACT FROM AUTHOR] |
| Databáze: |
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