A live birth resulting from a fourth cesarean scar pregnancy after combined hysteroscopic and laparoscopic uterine repair: A case report and literature review

Cesarean scar pregnancy(CSP)is a rare form of ectopic pregnancy that is defined as a pregnancy sac located within the scar of a previous cesarean section.Recurrent cesarean scar pregnancy(RCSP)is even more uncommon,1 with Hasegawa et al reporting the first RCSP in 2005.2 RCSP is a high-risk pregnancy condition with potential complications that include heavy bleeding,uterine rupture,and maternal shock.The exact incidence rates for CSP and RCSP are unknown,although the incidence of CSP is 1/2656–1/1800 of the total number of cesarean sections,and the incidence of RCSP can reach 6.9%–34.3%.3,4,5 With the promulgation of the second and third child policies in China,an increasing number of patients now manifest fertility needs after cesarean section.With improvements in examination methods and awareness of CSP,we also suspect that the rates of CSP and RCSP may be even higher.Unfortunately,there is no standard treatment for CSP.We herein report a case in which the patient was treated by combined hysteroscopic and laparoscopic uterine repair without scar resection during the third RCSP,and the fourth RCSP occurred 6 months later;the patient then selected expectant management.The outcome was a successful cesarean section delivery of a live baby at 34 weeks of gestation,and the uterus was successfully preserved.Placental pathology was examined after delivery and revealed that the chorionic villi penetrated deeply into the myometrium.