title: Hysteroscopic management of cesarean scar ectopic pregnancy.
abstract: OBJECTIVE
  To present our experience with hysteroscopic removal of cesarean scar ectopic pregnancy (CSP) and review the literature on the current management.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A tertiary referral university hospital, Sydney, Australia.
  
  
  METHODS
  Six patients diagnosed with CSP.
  
  
  METHODS
  Four patients were successfully treated with primary hysteroscopic removal of the ectopic pregnancy. Two patients were treated with systemic methotrexate (MTX), which failed; one patient had a subsequent hysteroscopic removal of CSP, and the second had local injection of MTX to the gestational sac.
  
  
  METHODS
  Clinical, serological, and ultrasound data and follow-up for subsequent pregnancies.
  
  
  RESULTS
  For the women treated surgically, the median time for the return of betahCG to <5 mIU/mL was 30 days, the mean operative time was 35 minutes, and the mean estimated blood loss was 140 mL. Three pregnancies were achieved: a miscarriage, a term pregnancy that resulted in a live birth, and an ongoing intrauterine pregnancy. The patient who was managed by MTX took 105 days for the betahCG to normalize and had an ongoing hematoma at the site of the CSP that took 247 days to resolve.
  
  
  CONCLUSIONS
  Hysteroscopic management of CSP offers advantages over local injection with MTX and systemic MTX with a more rapid return to normal betahCG level and reduction in follow-up time.
authors.affiliation: Department of Endo-Gynaecology, Royal Hospital for Women, Randwick, New South Wales, Australia. rebecca.deans@SESIAHS.health.nsw.gov.au
authors.forename: Rebecca
authors.initials: R
authors.lastname: Deans
authors.forename: Jason
authors.initials: J
authors.lastname: Abbott