生存胎芽を有する帝王切開瘢痕部妊娠に対し、ボール電極による剝離法を用いて一期的に子宮鏡下妊娠組織摘出術を行った1症例

抄録

  Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. The incidence of CSP is increasing with the growing rate of cesarean sections. Although several treatment options have been advocated, there is still no consensus regarding the management of CSP. We hereby report a case of CSP with a living fetus which was successfully treated by operative hysteroscopy without additional methods. The patient was a 32-year-old woman who underwent abdominal myomectomy followed by an elective cesarean section due to previous-uterine surgery. She was first diagnosed with CSP at 6 weeks of gestation by ultrasonography and magnetic resonance imaging. A living fetus was confirmed in the gestational sac located over the cesarean scar. We then elected to perform hysteroscopic resection because this CSP seemed to be of the endogenic type and the increase in blood flow around the gestational sac was still limited. To remove the gestational sac at the implantation site, we used a stripping technique with a roller electrode. This technique enabled us to pursue precise stripping of the gestational sac, as well as easy hemostasis of the surrounding vessels, which made it possible to treat CSP at a single time. As the CSP tissue was obtained intact, pathological analysis revealed a fetus, chorionic villi, and decidua, which clearly confirmed CSP.