750 - Ultrasound-Guided Microwave Ablation for Treatment of Cesarean Scar and Cornual Ectopic Pregnancies

Learning Objectives:

1. 
   Review the clinical presentation, diagnosis, and standard management strategies for cesarean scar pregnancies (CSEP) and cornual ectopic pregnancies
   
   


2. 
   Describe the role of ultrasound-guided (US-guided) microwave ablation (MWA) as a novel treatment technique
   
   


3. 
   Outline patient selection, procedural steps, outcomes, and future directions for research
   
   

Background: CSEP and cornual ectopic pregnancy are rare but life-threatening conditions with high risk of catastrophic hemorrhage, hysterectomy, and maternal mortality if not promptly managed. CSEP occurs in approximately 1 in 1,800 pregnancies and represents about 6% of ectopic pregnancies in women with prior cesarean delivery. Diagnosis relies on transvaginal ultrasound, though nonspecific symptoms often delay recognition. Traditional management strategies include local methotrexate injection, systemic therapy, hysteroscopic resection, or laparoscopic excision, often with significant morbidity. No universally accepted standard of care exists, and management must be individualized. US-guided MWA, via a transvaginal or transabdominal approach, is a novel, minimally-invasive alternative which has shown success in treating CSEP and cornual ectopic pregnancy and holds potential to treat broader ectopic sites.

Clinical Findings/Procedure Details: We describe a novel interventional radiology technique utilizing US-guided MWA for treatment of cesarean scar and cornual ectopic pregnancies. The procedure is performed under general anesthesia using the Emprint Percutaneous system with a 30 cm antenna. Ablation is carried out for at least 3 minutes, producing a clearly visualized ablation zone under real-time US guidance. Pre-procedure MRI is essential to confirm diagnosis, define ectopic location, and identify adjacent vital structures to ensure procedural safety. Both transvaginal and transabdominal approaches are feasible. We review patient selection, indications, contraindications, procedural endpoints, and potential complications. This technique provides direct, targeted ablation of ectopic gestational tissue while minimizing systemic toxicity and preserving fertility.

Conclusion and/or Teaching Points: US-guided MWA is a promising, minimally invasive option for management of CSEP and cornual ectopic pregnancies. The technique offers precise, image-guided tissue destruction with real-time confirmation of treatment zone, potentially reducing morbidity compared with surgery or systemic chemotherapy. Further evaluation in larger, randomized studies is warranted to establish efficacy, safety, and long-term fertility outcomes.