Resection of Cesarean Scar Pregnancy at Six Weeks of Gestati
In cases of fetal heartbeat- (FHB-) positive cesarean scar pregnancy (CSP), resecting the pregnancy contents as early as possible is recommended to avoid catastrophic outcomes such as uterine rupture or massive bleeding.
We experienced an FHB-positive CSP case at 6 weeks of gestation and were able to assess the CSP in detail using transvaginal ultrasound (TVUS) and transabdominal ultrasound (TAUS), preoperatively. We performed Laminaria cervical dilatation under TVUS and TAUS guidance to adequately visualize the CSP and to more easily resect the pregnancy contents. We also performed hysteroscopic resection of the pregnancy conceptus and curettage under TAUS guidance. We acquired images that demonstrated the gestational sac (GS) attached to the maternal uterus, decidua basalis, and chorionic villi with small plane. We discuss the clinical history and findings in this case. We also reviewed the related literature and found 76 previous studies, with six cases of FHB-positive CSP that contained hysteroscopic color images of the CSP. We present a review of selected cases.

Case Report
The patient was a 28-year-old female who had one miscarriage history and one cesarean section history for twin pregnancy at 36 weeks of gestation. She had been amenorrheal since her last menstrual period. Her menstrual cycle was 27 days and regular, and she was introduced to our hospital because of suspicion of CSP. She was presumed to be 6?w 0?d of gestation based on the date of her last menstrual period. TVUS showed that her cesarean scar defect site had enlarged to a triangular shape, with the presence of an 18.7?mm GS containing an FHB and yolk sac....
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