Authors: Vasilios T. Goudas
The aim of this paper is to present the first patient where a lower uterine segment transverse incision defect that led to a cesarean section scar ectopic pregnancy was repaired at the same time with Hysterotomy for removal of her persistent ectopic pregnancy. We also reviewed the literature.
Background: Cesarean Sections leave on occasion the lower uterine segment thinner with resulting consequences that range from bleeding, fluid in the cavity, pain, cramping and infertility. In addition, ectopic implantation at the cesarean section site is relatively common.
Case: A patient treated for infertility primarily resulting from lower uterine segment transverse incision deficit (LUSTID) is presented. After she conceived with IUI it was noted that she had an ectopic pregnancy. Methotrexate was given and the hCG declined but the gestational sac remained in the lower uterine segment with the mean diameter increasing. The patient underwent a laparotomy and hysterotomy, with hysteroscopic guidance. The pregnancy was removed and the incision was rejuvenated and re-approximated. The literature was searched for similar cases but none were found.
Discussion: LUSTID should be recognized as a cause of infertility and strongly considered in secondary infertility patients. This is the first case we identified in the literature with primary intent hysterotomy for a cesarean section scar ectopic removal and repair. We also propose criteria for surgical intervention.
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