Abstract
Caesarean Scar Ectopic Pregnancy (CSEP) is a rare, but potentially catastrophic complication of a previous Caesarean Section (CS) birth. This is a review of 5 cases of CSEP managed in our Early Pregnancy Unit at Watford General Hospital within a 10-month period. Two patients had only one previous CS, whilst 2 had two and the last had 3 previous CS. All our patients presented within the first trimester of pregnancy (range 6 to 11 weeks’ gestation) with light vaginal bleeding; 4 of them had associated mild to moderate abdominal pain. All were diagnosed using transvaginal ultrasound scan. Three of our patients were managed surgically by Suction Evacuation under Ultrasound guidance and insertion of a Foley’s catheter prophylactically for tamponade in order to reduce blood loss both intra- and post-operatively. One of our patients had a heterotopic pregnancy with a viable intrauterine pregnancy and a live CSEP. She declined any intervention so she was managed conservatively with weekly Consultant appointments and scans. There was a subsequent demise of the CSEP and she continued with a singleton pregnancy. None of our patients were managed medically. There is no absolute consensus on diagnostic criteria and there is no standard management protocol so each woman should be given all the available information and the opportunity to decide on the management of her pregnancy. The risk of a CSEP in a subsequent pregnancy should be part of the consent process for CS.
Highlights
The first case of a Caesarean Scar Ectopic Pregnancy (CSEP) was reported in English medical literature in 1978 [1]
Nine percent of patients will present with only abdominal pain, whilst 37% will be completely asymptomatic [5], the need for a high index of suspicion whilst scanning patients who have had a previous Caesarean Section (CS). β-hCG levels ranged from 2996 to 33,197, with higher levels being associated with live CSEP
There is no absolute consensus on diagnostic criteria, but generally these should include an empty uterus and cervical canal, ruling out an intrauterine pregnancy or miscarriage and a cervical ectopic pregnancy
Summary
The first case of a Caesarean Scar Ectopic Pregnancy (CSEP) was reported in English medical literature in 1978 [1]. There has been an increase in the number of publications about CSEPs (Figure 1). “true” increase in its incidence because of the rising caesarean section rate or an “apparent” one as result of better detection of the CSEP [2]. A CSEP results when an embryo implants in a previous Caesarean Section (CS) fibrous tissue scar. The damage to the decidua basalis during a CS persists in the endometrium in the form of tiny wedge defects This defect forms a tract between the endometrial canal and the CS scar through which the embryo can invade the myometrium [4]. We present 5 cases of CSEPs that we managed in our Early Pregnancy Unit at Watford General Hospital within a 10-month period
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