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Cesarean scar pregnancy; an institutional experience

Abstract

Objective: To compare the efficacy of laparotomy versus vaginal dilatation and evacuation in the management of cesarean scar pregnancy in low resource setting. Study Design: Comparative interventional study Place and Duration: Gynaecology department of Nishtar Medical University from 1st June, 2016 to 30th May, 2017 over the period of one year. Methodology: Total 24 patients were included in study, divided on the basis of treatment modality in two groups, group-A underwent laparotomy and resection of cesarean scar pregnancy while group-B underwent dilatation and evacuation of products of conception vaginally. Independent sample t-test is applied to compare the performance of two procedures by comparing integrity of scar, operative time, blood transfusion and intra peritoneal hemorrhage. Results: Patients of group-A underwent laparotomy. There was intact scar, no blood transfusion and shorter operative time (30±15min) with smooth recovery. Patients of groups-B underwent dilatation and evacuation vaginally, 83.3% patients had moderate bleeding so their procedure was converted to laparotomy immediately and 16.7 % patients underwent laparotomy after period of observation because of hypovolemic shock. In this group 33.3% patients were found to have disrupted scar, 33.3% had intraperitoneal hemorrhage, 16.7% had blood transfusions and longer operation time (60±15min). Conclusion: Laparotomy is better than vaginal procedure to reduce morbidity in cesarean scar pregnancy in low resource setting.

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