Viable Caesarean Scar Pregnancy: A Case Report

Abstract

Ectopic pregnancy is a pregnancy in which blastocyst is implanted at a site other than the endometrium. When it is partially or completely implanted with in the scar it is known as caesarean scar ectopic pregnancy (CSP). It is a very rare form of the ectopic pregnancy and most of the literature available is in the form of case reports and case series. In the succeeding report of a case, a 31 years old gravida-4 para-2 with one miscarriage and one caesarean section presented in emergency department with the amenorrhea of 9 weeks and 5 days. She had moderate abdominal pain and vaginal bleeding. After in-patient evaluation she was diagnosed of having viable CSP, necessitating termination of pregnancy. The challenge after the diagnosis was to remove the CSP and retain future fertility without increasing the morbidity. Uterine artery embolization (UAE) followed by the laparotomy and excision of the ectopic pregnancy was carried out to reduce the risk of the hemorrhage. Early and accurate diagnosis is the key and should be followed by individualized prompt treatment in expert hands. A multidisciplinary approach is essential to reduce the overall morbidity and help retaining the future fertility of the patient.

Manual Vacuum Aspiration Alone Versus Manual Vacuum Aspiration Preceded by Methotrexate in Management of Caesarean Scar Pregnancy

“…There are two types of CSP; endogenous where the gestational sac is implanted at the site of previous caesarean scar and develops towards the uterine cavity and exogenous where the sac is implanted into the CS defect and grows towards the uterine serosa and urinary bladder [4] . The exact pathogenesis is not clearly understood but the endometrial and myometrial disruption could be the predisposing factors in abnormal uterine implantation [5] .…”

Evaluation of management of Cesarean Scar Pregnancy (CSP).

“…6 Surgical treatment may be done by hysteroscopy, laparoscopy and laparotomy depending on size of gestational sac, presence of fetal cardiac activity and hemodynamic stability of the patient. 7 In our study we evaluated our experience of diagnosis of CSP in 12 patients using by transvaginal ultrasound and color flow Doppler studies. The aim of their management was conservation of fertility.…”