Caesarean Scar Ectopic Pregnancy: Report of Two Cases

Abstract

Cases of Caesarean Scar Ectopic Pregnancy (CSEP) are becoming increasingly common at tertiary care hospitals because of increase in rate of CS. This condition is often complicated by life threatening bleeding, uterine rupture, which might require hysterectomy leading to permanent infertility. Management can be medical, surgical or combined depending on the clinical presentation. It includes systemic methotrexate or local uterine artery chemoembolisation, dilatation and curettage, excision of trophoblastic tissue either by laparoscopy or laparotomy with uterine repair. We report two such cases managed medically in our hospital. Both the cases presented to us were asymptomatic except amenorrhoea and were diagnosed by transvaginal sonography. First case was managed with systemic methotrexate followed by Dilatation and Curettage (D&C). Second case was managed with systemic methotrexate alone successfully.

Keywords: Embolisation; Hysterectomy; Laparoscopy; Laparotomy; Methotrexate.

[Table/Fig-1]:

TVS showing intrauterine gestational sac and part of chorionic tissue is imaged in the previous LSCS scar region slightly invaginating into the anterior wall.

[Table/Fig-2]:

TVS gestational sac of 5×3 mm at the lower end of the endometrial cavity.

[Table/Fig-3]:

Trans Abdominal Sonography (TAS) showing sac located anteriorly and 4mm from uterine serosa