MyoSure in management of cornual ectopic pregnancy

Successful Use of Myosure in the Management of Cesarean Scar Ectopic Pregnancy

Cesarean scar pregnancy (CSP) is a very serious complication of a prior cesarean delivery. The major risks associated with CSP are uncontrolled hemorrhage and uterine rupture, potentially leading to future infertility. Management of CSP remains a major obstetric challenge without a well-defined therapeutic procedure. Dilation & curettage is a commonly used procedure for the treatment of CSP. However, it can be ineffective and often leads to definite infertility. Therefore, we present a case of the successful use of an alternative procedure, Myosure® hysteroscopy, in the treatment of CSP. We herein report the case of a 32-year-old G5P3013 woman who presented with vaginal bleeding and past history of three cesarean sections. She was found to have a CSP with fetal pole and cardiac activity at 6 weeks 2 days. The patient was initially treated with a systemic methotrexate injection, but there was persistence of cardiac activity. A second course of methotrexate was administered into the gestational sac, which systemically led to successful fetal cardiac arrest and downtrend of beta-human chorionic gonadotropin (HCG) level. A dilation & curettage procedure was not successful in removing products of conception. A Myosure hysteroscopy procedure, however, was successful in removing products of conception. The patient was discharged after a negative ultrasound and beta-HCG level. In our review of the literature, we found that there is no general consensus on the management of cesarean scar ectopic pregnancies. To date, there is no literature cited about the use of Myosure for cesarean scar ectopic pregnancies. However, our case suggests that Myosure can be effective for CSP and this warrants a larger-scale controlled study to better evaluate this as a treatment for this condition.

Two cases of larger cornual residual villi, treated by the hysteroscopic cold knife

The present report describes two cases of larger cornual residual villi after dilatation and curettage because of missed abortion, treated by the hysteroscopic cold knife. One case is 39 years old and the other is 30 years old, both cases were treated with dilatation and curettage because of missed abortion, surprisingly, one of the patients suffered two curettage surgeries. After the curettage, with irregular vaginal bleeding more than 3 months, pelvic ultrasonography revealed an enlarged uterine cavity with a lager cornual residual villi was suspected. We treated them with Hysteroscopy Endo-Operative System, the operation was successful without any complications. The blood β-HCG drops rapidly to normal after surgery. We performed office hysteroscopy for them 1 month after the operation, and the corners of uterine were normal. The hysteroscopic cold knife may represent a valid tool for the treatment of large cornual residual villi.