title: Uterine-preserving emergency surgery for cesarean scar pregnancies: another medical solution to an iatrogenic problem.
abstract: OBJECTIVE
  To supplement existing cases of cesarean scar pregnancy presenting as acute conditions. All of the study women had been treated by a conservative surgical approach.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Department of obstetrics/gynecology of a tertiary referral center.
  
  
  METHODS
  We identified six pregnant women at 7-15 weeks' gestation who underwent emergency laparotomy and uterine-preserving surgery. Four of them were initially treated by uterine curettage because of misdiagnosed intrauterine pregnancies. The other two experienced failed methotrexate treatment.
  
  
  METHODS
  All patients underwent a similar surgical technique while actively bleeding. This included laparotomy and ligation of bilateral uterine arteries, followed by wedge resection of the entire pregnancy in scar. The uterus was sutured in two layers.
  
  
  METHODS
  All the reported women in our series had been cured and their uteruses have been preserved.
  
  
  RESULTS
  There was an inadvertent injury to the bladder in one case, which was immediately repaired, and blood transfusion was required in two other cases. The postoperative course was uneventful for all the patients. One of the patients has already spontaneously conceived and she had an ongoing normal pregnancy at the time of writing.
  
  
  CONCLUSIONS
  This small case series emphasizes that uterine-preserving surgery is an optional management for cesarean scar pregnancies presenting as acute conditions, cases resistant to medical treatment, or for women at advanced gestation.
authors.affiliation: Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Zerifin, Israel. maxia@asaf.health.gov.il
authors.forename: Reuvit
authors.initials: R
authors.lastname: Halperin
authors.forename: David
authors.initials: D
authors.lastname: Schneider
authors.forename: Sonia
authors.initials: S
authors.lastname: Mendlovic
authors.forename: Moty
authors.initials: M
authors.lastname: Pansky
authors.forename: Arie
authors.initials: A
authors.lastname: Herman
authors.forename: Ron
authors.initials: R
authors.lastname: Maymon
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D002921:Cicatrix / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*