Rarest of All – A Case of Cesarean Scar Ectopic Pregnancy in an Elderly Woman

Abstract

One of the most common causes of mortality of females in the first trimester is ectopic pregnancy. Ectopic pregnancy can occur at different anatomic locations of which the fallopian tube is most common. Very rarely implantation of blastocyst can occur in the lower uterine segment at the site of the previous transverse cesarean section; this very rare type of ectopic pregnancy is known as cesarean scar pregnancy. Cesarean scar pregnancy is usually associated with the risk of uterine rupture leading to hemorrhage and hence diagnosis at an early stage and a proper management is necessary to avoid any serious complications. We present an interesting case of a 39-year-old elderly woman of G3P2 L2 who complained of amenorrhea for the past 7 weeks. Her urine tested positive for β-human chorionic gonadotropin, and she was further sent for antenatal ultrasound scan to confirm the pregnancy. On transvaginal ultrasound examination, there was a single gestational sac with yolk sac, fetal pole, and cardiac activity seen at the anterior end of the lower uterine segment near the old healed scar of the previous cesarean section corresponding to the gestational age of 6 weeks and 6 days. A diagnosis of cesarean scar ectopic pregnancy was made. The woman underwent a laparotomy with excision and termination of the pregnancy. Ectopic pregnancy of any location should be promptly diagnosed and adequately treated. In cases where transvaginal ultrasonography is inconclusive, magnetic resonance imaging is performed. Diagnosis is important to avoid any further complications and in young females to preserve fertility.