VP01.17: Rare case of type‐2 Caesarean scar ectopic pregnancy

Abstract

A Caesarean scar pregnancy (CSP) is implantation of blastocyst in the scarred or fibrosed uterine myometrium of a previous Caesarean delivery scar. Though CSP is rare, ectopic mindedness is very important while performing early pregnancy scans, specifically in women with previous Caesarean delivery. Timely diagnosis is of critical importance for quick intervention of this dangerous condition as undiagnosed CSP may progress to invasive placenta, uterine rupture, hemorrhage and possibly maternal death. Two different types of scar ectopic pregnancies are described. Type 1 is caused by implantation in the previous Caesarean scar with progression towards the cervicoisthmic space or the uterine cavity. This type of pregnancy may progress till term, but associated with complications like morbidly adherent placenta. Type 2 is caused by deep implantation into scar defect with trophoblastic infiltration into the uterine myometrium and to uterine serosal surface which may result into uterine rupture and massive hemorrhage in first trimester of pregnancy. We present an interesting case of type 2 CSP. The intact gestational sac was in the scar with extension beyond the serosa up to the anterior abdominal wall, with invasion of the abdominal muscle layer. The sac was also extending in the intrauterine cavity. The sac showed a demised embryo of 6 weeks. Extensive vascularity noted along the serosal breach as well as at abdominal wall invasion site. The findings were confirmed on laprohysterocopy. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.