Cesarean section scar ectopic pregnancy - a management conundrum: a case report

Abstract

Background Cesarean section scar ectopic pregnancies are a rare complication of pregnancy that may follow previous hysterotomy for any cause, uterine manipulation, and in vitro fertilization. It has become more common with the increasing number of cesarean sections worldwide. Fortunately, the use of first-trimester ultrasound imaging has led to a significant number of these pregnancies being diagnosed and managed early. Case presentation We report a case of a 36-year-old black African patient who had two previous cesarean sections and one previous surgical evacuation. She presented with a type 2 cesarean section scar ectopic pregnancy that was suspected on the basis of transvaginal ultrasound imaging, but not at laparoscopy/hysteroscopy. A bladder adherent to the upper segment of the anterior uterine wall obscured the gestational mass at laparoscopy. There were extensive intracavitary adhesions that interfered with hysteroscopic visualization. This resulted in the original operative procedure being postponed until magnetic resonance imaging confirmed the ectopic location of the pregnancy. The ectopic gestation was subsequently excised, and the uterus was repaired via laparotomy. Conclusions It is important for clinicians and radiologists managing women with risk factors for a scar ectopic pregnancy to maintain a high index of suspicion during follow-up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal death.

Viable Caesarean Scar Pregnancy: A Case Report

“…5,12 Though theoretically the risk seems low in the patient under discussion because of the restoration of the normal reproductive anatomy, recurrence, however, is reported after surgical repair as well. 15 This suggests a future scope of more research to identify the elements and factors that may help in reduction of recurrence.…”

Cesarean Scar – Unusual Site of Ectopic Pregnancy: A Case Report

“…The first case of scar ectopic pregnancy was reported by Larsen and Solomon in 1978 [4]. Although considered a rare type of pregnancy, the incidence of cesarean scar ectopic pregnancy is increasing owing to the increasing rates of cesarean deliveries worldwide [5, 6].…”

“…In our case, the patient had four previous cesarean section deliveries which predisposed her for ectopic pregnancy. Interestingly, the risk of cesarean scar pregnancy appears to be unrelated to the number of previous cesarean deliveries [5, 6].…”

Conservative Management of Cesarean Scar Ectopic Pregnancy: A Case Series

“…4 Choice of treatment depends on the case presentation and usually managed by medically with methotrexate or surgically. 5 The outmost aim of this present case series is that as cesarean scar ectopic pregnancies are a rarest presentation so difficult to diagnose and for which a management option may be hard to choose. This present case series patients diagnosed with transvaginal ultrasound (TVUS) confirmed with histopathology and successfully treated conservatively with methotrexate.…”