Abstract
Introduction. Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy. Given their rarity, there is lack of consensus regarding the management and natural course of CSPs. Case. A 37-year-old G10 P3063 female with a history of two prior cesarean deliveries was diagnosed with her second CSP at 6 weeks and 5 days in her tenth pregnancy. The patient underwent vertical hysterotomy, excision of a gestational sac implanted in the cesarean sac, and bilateral salpingectomy via a laparotomy incision. The histopathology report confirmed immature chorionic villi. The patient returned 10 weeks later and was found to be still pregnant. Obstetric ultrasound confirmed a viable fetus of 19 weeks and 4 days of gestational age with a thin endometrium and an anteroposterior and right lateral placenta with multiple placental lakes. The patient ruptured her membranes at 31 weeks of gestation and pelvic MRI revealed an anterior placenta invading the myometrium and extending to the external serosal surface consistent with placenta increta. Following obstetric interventions, a live female infant was delivered by cesarean hysterectomy (because of placenta increta) at 32 weeks of gestation. Conclusion. Development of standardized guidelines for management of CSPs, as well as heightened vigilance for possible complications, is required for proper care and avoidance of potential morbidity and mortality.
Highlights
Cesarean scar pregnancies (CSPs) are one of the rarest forms of ectopic pregnancy
We report a case of a recurrent CSP managed with surgical excision that was complicated by a persistent pregnancy that survived to viability and was delivered at 32 weeks of gestation by cesarean hysterectomy because of placenta increta
We report a unique case of recurrent CSP managed with surgical excision
Summary
A cesarean scar pregnancy (CSP) is defined as the implantation of a fertilized ovum outside the uterus but within the fibrous tissue of a previous cesarean section scar [1]. The alarming increase in what was once considered a rare iatrogenic complication has been postulated to be due to two main factors: a significant rise in the number of cesarean deliveries worldwide and the increased use of transvaginal ultrasound (TVUS) for the diagnosis of early pregnancies [6]. Both elements provide an increase in the main risk factor for the development of a CSP, and a means for its diagnosis. We report a case of a recurrent CSP managed with surgical excision that was complicated by a persistent pregnancy that survived to viability and was delivered at 32 weeks of gestation by cesarean hysterectomy because of placenta increta
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