AFJOG

REVIEW Laparoscopic resection of CSP This is the most effective treatment for any category of CSP, and it has the most rapid decline of serum β-hCG, and reduced hospital stay, with preservation of fertility. It is however the more costly remedy, and it requires highly skilled personnel and high-tech equipment that is not always universally available. Laparotomy In unstable CSP patients especially following rupture of the uterus in late pregnancy, laparotomy may be the best option to minimize haemodynamic instability and assessment of the feasibility of conservation of the uterus. It is also an option in settings with limited resources and skills for minimal invasive surgery with patients unable to stick to prolonged follow-up schedules associated with expectant or medical treatment. Adjunctive treatment options for CSP Uterine artery embolization, intragestational injections such as potassium chloride or absolute alcohol and balloon catheters are mainly used in combination or as adjunctive treatments to increase the effectiveness of other medical and surgical modalities and prevent severe haemorrhage among patients with high serum β-hCG, and gestational sacs with rich blood supply. 38-41 Transvaginal resection Transvaginal resection of the CSP and repair is carried out by approaching the peritoneal cavity through the anterior cervical vaginal junction, reflecting the bladder from the anterior aspect of the cervix to expose the lesion. 42 Compared to laparotomy for resection of the CSP, it is associated with a short operation time, less surgical trauma, reduced intraoperative blood loss, and a shorter hospital stay. It is a simple and feasible surgical approach given less sophisticated equipment and surgical skills compared to laparoscopic resection with comparable results. 43 Compared to medical therapy, there is a quick reduction in serum β-hCG levels and rapid menstruation recovery. Transvaginal resection is cost- effective, especially in low-resource setting institutions where transvaginal surgery is routinely done. Conclusion The primary goals of preventing severe morbidity as well as preserving fertility for patients presenting with CSP are best achieved with minimally invasive treatment modalities such as laparoscopic and hysteroscopic resection in settings with adequate skills and resources, and where these are not readily available, transvaginal resection or resection at laparotomy can achieve similar success rates. Successful use of other modalities has been reported following the appropriate selection of patients who fit the method-specific criteria with due consideration of the availability and cost of ancillary therapeutic services that may be required. It is prudent to counsel all women who undergo caesarean delivery to have an early first-trimester scan in all their subsequent pregnancies to screen for CSP. As point-of-care ultrasound is becoming more available at lower levels of care including district hospitals and health centres, it is necessary to implement in-service training of qualified personnel and to update the curricula of medical trainees to impart skills that can help diagnose and appropriately manage conditions such as CSP whose incidence is gradually increasing yet are prone to adverse outcomes when not diagnosed timeously and appropriately managed. REFERENCES ¡ ¡ ¡ ¢ £ ¤ £ ¥ £ ¦ § £ ¤ £ ¤ £ African Journal of Obstetrics and Gynaecology | Volume 1 | Issue 2 | 2023 | 08