Ectopic pregnancy with implanted gestational sac in the cesarean scar

Abstract

Introduction: Implantation of a pregnancy in the cesarean scar is considered a rarest presentation of ectopic pregnancy with high morbidity and mortality. The use of imaging tests is capable of early diagnosing such cases and assisting in the management of pregnancy. The present article reports two cases of ectopic pregnancy in the cesarean scar, illustrating the main aspects in ultrasound tomography (UST) and magnetic resonance imaging (MRI) exams. In addition, a bibliographic search was carried out in a database that presented data about this clinical condition. Case Series: Case 1: A 44-year-old patient, without comorbidities, G2P1cA0, with a pregnancy of 9w4d, admitted with bleeding for 03 days. Ultrasound tomography showed a single gestational sac with an embryo of anomalous morphology, with no heartbeat and in isthmic topography, in an exophytic position, over the topography of a scar from a previous cesarean section. The initial diagnosis was placental accreta. After MRI of the pelvis, an ectopic pregnancy with a gestational sac implanted in the cesarean section scar (type II—exogenous), with signs of trophoblast/placental accreta. Case 2: A 30-year-old patient, without comorbidities, G2P1c, with a 7w3d pregnancy, with abdominal pain. Ultrasound tomography showed a single gestational sac with a gestational sac implanted in the cesarean section scar, transmural type I (endogenous), which was later confirmed by pelvic MRI. Conclusion: It is necessary to highlight the importance of early diagnosis of ectopic pregnancy with implantation in a cesarean scar, given the possibility of making an appropriate therapeutic decision depending on the clinical context, aiming to reduce the possible complications of the condition.