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C- section scar ectopic pregnancy- a case report

C- section scar ectopic pregnancy- a case report

A case study published in the Journal of Medical case reports demonstrated a case of a 36-years-old woman who was presented with a type 2 cesarean section scar ectopic pregnancy that was suspected on the basis of transvaginal ultrasound imaging.

Scar ectopic pregnancy is becoming increasingly common all over the globe. It is a novel and life-threatening form of abnormal implantation of an embryo within the myometrium and the fibrous tissue of the previous scar following cesarean section; hysterotomy; dilation and curettage; abnormal placentation; surgery on uterus like myomectomy, metroplasty, hysteroscopy and manual removal of placenta.

This is a case of a 36 years old woman from Africa patient who had two previous cesarean sections and one previous surgical evacuation. She diagnosed 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 laparotom

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The authors stated in the case study that although the patient had undergone three previous uterine procedures, one case series shows that most scar ectopic pregnancies occurred just after only once cesarian. Hence, the number of cesarean sections appear to have no impact as an independent risk factor 

Taking a cue from the case, the authors advised that 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.

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  1. user
    Dr. P K Sekharan June 1, 2019, 5:44 am

    Pregnancy following C.section should be carefully evaluated by TVS for early diagnosis scar ectopic pregnancy. Presence gestational sac in the lower anterior uterine wall is suspicious. Conformation of the diagnosis is by 3-D ultrasound and MRI. Early diagnosis will help to treat the case medically using Methotrexate. Late cases will require surgical intervention- Laparoscopic/Hysteroscopic Resection. Laparotomy may be necessary in case of rupture for resection of the mass and repair of the uterus.
    We had three cases of caesarean scar ectopic all of them at 11 and 12wks who failed to resolve with Methotrexate and required surgical resection and repair. One patient conceived afterwards and delivered
    by caesarean section at 37 weeks. All were following one caesarean section.

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