Cesarean Scar Ectopic Pregnancy: A Diagnostic and Management Challenge.

Koulshan Jameel,Rabiya Niaz,Durr-E-Shahwar Hayat,Gul-E-Rana Abdul Mannan

doi:10.7759/cureus.14463

Koulshan Jameel, Rabiya Niaz + Show 2 more

Open Access

https://doi.org/10.7759/cureus.14463

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Abstract

Cesarean section scar pregnancy is the rarest form of ectopic pregnancy. Cesarean scar ectopic pregnancy poses a diagnostic and management challenge, and if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity or mortality. We describe the presentation, workup including radiology studies, and subsequent management plan of a cesarean scar ectopic pregnancy in a 34-year-old female with a history of four previous cesarean sections. We were successful in treating this rare form of ectopic pregnancy without any maternal morbidity with a combination of medical and surgical management.

Highlights

With the increase in the incidence of cesarean section, any subsequent risks of placenta previa, placenta accreta, and ectopic pregnancy have increased
Cesarean section scar pregnancy is the rarest form of ectopic pregnancy
Cesarean scar ectopic pregnancy poses a diagnostic and management challenge, and if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity or mortality

Summary

Introduction

With the increase in the incidence of cesarean section, any subsequent risks of placenta previa, placenta accreta, and ectopic pregnancy have increased. Vial et al [2] proposed that there are two different kinds of cesarean scar ectopic pregnancies, one that grows inside into the uterine cavity as gestational sac develops and has the potential to reach viable gestation but with risk of placenta accreta and major obstetric hemorrhage-the endogenous type. Transabdominal ultrasound was done that showed 6 mm single small gestational sac with yolk sac of five weeks located in the anterior part of lower uterine segment at cesarean scar (Figure 1); myometrium between bladder wall and gestational sac was absent; uterine cavity was empty; findings were consistent with cesarean scar ectopic pregnancy. The patient got admitted to hospital for administration of injection methotrexate Her β-hCG level on that day was 22,657 mIU/mL. Histopathology report of the product of conception excluded any other pathology

Discussion

Conclusions

Disclosures

10. Fylstra DL