Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases

To propose a novel procedure as a safe and effective treatment for cesarean scar pregnancy (CSP), a cohort study was initiated in patients diagnosed with CSP and treated with transvaginal hysterotomy from December 2009 to March 2013, either as a primary or secondary therapy. All diagnoses were confirmed by both sonography and pathology, either a gestational sac or residual tissue after termination of pregnancy or miscarriage in the cesarean section scar. Basic clinical characteristics and perioperative data were collected and analyzed. A total of 40 patients were included. The mean age was 32.88 +/- 4.55 years. The mean size of gestational sacs of the CSP mass at diagnosis was 33.78 +/- 13.14 mm. Mean serum beta-hCG level at diagnosis was 47379.73 +/- 45285.10 IU/L. Mean operative time was 57.25 +/- 24.52 min. Mean postoperative hemoglobin drop was 1.635 +/- 0.906 g/dL. Complications were one case of bacteremia and two cases of hematoma. Mean hospital stay after surgery was 4.95 +/- 2.62 days. Mean serum beta-hCG levels decreased by 88.5, 93.5, and 96.5 % at postoperative day 2, 4, and 6, respectively. All patients' beta-hCG levels returned to normal range within 1 month after surgery. Transvaginal hysterotomy with removal of ectopic pregnancy tissue and repair of cesarean scar defect is a promising approach to manage CSPs, with a short hospital stay, low postoperative pain, blood loss, and cost.