Cesarean Section–Scar Pregnancy: High Index of Clinical Suspicion is Required

Abstract

Background: Cesarean section-scar pregnancy (CSP) is a relatively rare form of ectopic pregnancy but is increasing in incidence with the increases in cesarean sections that are occurring. Case: A 26-year-old woman, gravida 2, para 1, was misdiagnosed as having a miscarriage when she presented with bleeding from her vagina. She underwent two dilatation and evacuation (D&E) procedures, both of which failed to stop her bleeding. After undergoing magnetic resonance imaging MRI, however, she was found to have a CSP. The CSP was treated successfully with a single dose of methotrexate. Results: The patient's pregnancy-related mass disappeared completely on day 72 post-treatement. She was counseled regarding contraception and was encouraged to come in early for her next pregnancy to undergo an early scan to determine the exact location of the new pregnancy. Conclusions: Massive bleeding after procedures such as D&E should raise the suspicion of CSP in high-risk cases. Sonographers should follow strict criteria to assess if any pregnancy is implanted at the site of a previous cesarean scar. MRI can play an adjunct role in evaluating a patient for CSP. Early diagnosis and treatment can prevent obstetric emergencies. CSP can be treated successfully with methotrexate. It is important to maintain a high level of suspicion for the diagnosis of CSP, as it can be easily misdiagnosed, which was what occurred in the current case. ( J GYNECOL SURG 31:92)