Successful treatment of cesarean scar pregnancy using laparoscopically assisted local injection of etoposide with transvaginal ultrasound guidance Ching-Hui.

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Successful treatment of cesarean scar pregnancy using laparoscopically assisted local injection of etoposide with transvaginal ultrasound guidance Ching-Hui Chen, M.D., Peng-Hui Wang, M.D., Ph.D., Wei-Min Liu, M.D. Fertility and Sterility Volume 92, Issue 5, Pages 1747.e9-1747.e11 (November 2009) DOI: 10.1016/j.fertnstert.2009.08.021 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Ultrasound image of the uterus showing a protrusion of the gestation sac toward the bladder and abdominal cavity, with empty uterine cavity. Green arrow indicates the cervix. Red arrow indicates the extending line of the endometrium, showing empty uterine cavity. Blue arrow indicates the gestation sac, measuring 1.9×1.7 cm, located on the lower segment of the anterior uterine wall. Fertility and Sterility 2009 92, 1747.e9-1747.e11DOI: (10.1016/j.fertnstert.2009.08.021) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Arrow indicates an ecchymotic lesion bulging from the lower segment of the anterior uterine wall (the previous cesarean scar area) before careful laparoscopic adhesiolysis. Fertility and Sterility 2009 92, 1747.e9-1747.e11DOI: (10.1016/j.fertnstert.2009.08.021) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Etoposide (100 mg VP-16) was injected into the ectopic sac by laparoscopy with the assistance of TVUS, then immediately sealed by bipolar electrocoagulation. Fertility and Sterility 2009 92, 1747.e9-1747.e11DOI: (10.1016/j.fertnstert.2009.08.021) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 4 Serum β-hCG levels and clinical course of the patient with cesarean scar pregnancy. Arrow indicates the time point of the TVUS-guided laparoscopic local injection of etoposide. Fertility and Sterility 2009 92, 1747.e9-1747.e11DOI: (10.1016/j.fertnstert.2009.08.021) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions