Laparoscopic Excision of Cesarean Scar Pregnancy Using Temporary Foley Tourniquet Occlusion and Scar Repair: A Case Report

Abstract

Introduction: Cesarean scar pregnancy is a rare ectopic implantation within a prior cesarean scar and carries substantial risk of severe hemorrhage, uterine rupture, and progression toward placenta accreta spectrum if not recognized early. Early diagnosis and individualized management are essential, particularly when uterine preservation is desired.

Case Presentation: A 30-year-old woman, gravida 3 para 2, with two previous cesarean deliveries, was referred after transvaginal ultrasonography demonstrated a gestational sac implanted in the anterior lower uterine segment at the cesarean scar niche, with an empty uterine cavity. Gestational age was approximately 8 to 10 weeks by last menstrual period, whereas sac size corresponded to 7 weeks 1 day on ultrasound. Residual myometrial thickness was 12.7 mm. She was hemodynamically stable and reported no vaginal bleeding or pelvic pain. Given the gestational age window, the scar implantation characteristics, and fertility-preserving intent, operative management was selected. Laparoscopy confirmed scar implantation. Temporary uterine vessel occlusion was achieved using a size 14 Foley catheter applied as a tourniquet to reduce uterine inflow. The gestational tissue was excised, followed by layered reconstruction of the lower uterine segment. Estimated blood loss was 150 mL, and transfusion was not required. Postoperative recovery was uncomplicated, and histopathology confirmed products of conception consistent with ectopic implantation.

Conclusion: In carefully selected patients with cesarean scar pregnancy at 8 to 10 weeks of gestation, laparoscopic excision with scar repair supported by temporary Foley tourniquet occlusion may provide effective hemorrhage control and uterine preservation.