Abstract
Ectopic pregnancy is a leading cause of maternal mortality in the first trimester. It may occur in different anatomic locations with fallopian tube being the most frequent. Cesarean-scar ectopic pregnancy is one of the rarest ectopic pregnancies. We report the case of a 44-year-old woman, gravida 5 para 4, who attended the antenatal clinic after her pregnancy was confirmed by positive urine testing. She underwent transvaginal ultrasound examination which identified the gestational sac with fetal pole and cardiac activity located in the anterior part of the lower uterine segment with empty uterine cavity. Magnetic resonance imaging (MRI) scan had confirmed the diagnosis of cesarean scar ectopic pregnancy. After through discussion on the management options, the patient was treated with intra-gestational sac injection of methotrexate. Four days after the procedure, she developed profuse vaginal bleeding and her hemoglobin showed a drop of 4.9 g/dL. She underwent emergency laparotomy with excision of the ectopic pregnancy. The patient tolerated the procedure well without complications. The serum β-human chorionic gonadotropin level was undetectable on the 35th day after the methotrexate injection. Caesarean scar pregnancy is an unusual form of ectopic pregnancy. However, clinicians should have a high index of suspicion for this condition as it may result in serious complications, unless promptly managed. MRI is recommended particularly when transvaginal ultrasound scan is inconclusive.
Highlights
Ectopic pregnancy refers to pregnancy in which the developing blastocyst implants at site other than the endometrial cavity
We report the case of a 44-year-old woman, gravida 5 para 4, who attended the antenatal clinic after her pregnancy was confirmed by positive urine testing. She underwent transvaginal ultrasound examination which identified the gestational sac with fetal pole and cardiac activity located in the anterior part of the lower uterine segment with empty uterine cavity
Magnetic resonance imaging (MRI) scan had confirmed the diagnosis of cesarean scar ectopic pregnancy
Summary
Ectopic pregnancy refers to pregnancy in which the developing blastocyst implants at site other than the endometrial cavity. Sagittal T2-weighted MRI of the pelvis demonstrating a gestational sac (arrow) implanted within the anterior wall of the lower uterine segment in the region of previous cesarean scar. Urgent abdominal computed tomography scan was performed and it demonstrated a bulky uterus with a cystic structure that was surrounded by hyperdense attenuation at the junction of middle and lower thirds of the uterus along with the presence of high volume of high-density fluid in the abdominopelvic cavity (Figure 3) These findings indicated hemoperitoneum due to a ruptured ectopic scar pregnancy. Sagittal CT scan image demonstrating the gestational sac (arrow) and high-density fluid collection (arrow head) suggestive of hemoperitoneum
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