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Case Reports
. 2021 Apr 8;57(4):362.
doi: 10.3390/medicina57040362.

Cesarean Scar Ectopic Pregnancy-Case Series: Treatment Decision Algorithm and Success with Medical Treatment

Lorena Sabonet Morente  1 , Ana I Guzmán León  1 , M Pilar Espejo Reina  1 , Jose R Anderica Herrero  1 , Ernesto González Mesa  1 , Jesús S Jiménez López  1
Affiliations
Case Reports

Cesarean Scar Ectopic Pregnancy-Case Series: Treatment Decision Algorithm and Success with Medical Treatment

Lorena Sabonet Morente et al. Medicina (Kaunas). .

Abstract

Background: Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation: We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow-up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon's skill and patient presentation. A transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion: Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow Doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.

Keywords: cesarean scar; ectopic pregnancy.

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Conflict of interest statement

In this study, there is no conflicts of interest.

Figures

Figure 1
Figure 1
Cesarean scar ectopic pregnancy.
Figure 2
Figure 2
A sagittal transvaginal image showing a gestational sac implanted in the scar area of the previous cesarean with a 3.6 mm embryo.
Figure 3
Figure 3
The bladder was released from a gestational sac.
Figure 4
Figure 4
A 13-week visible gestational sac and prolapse after rupture of the uterine segment.
Figure 5
Figure 5
Ultrasound displaying (at left and right) a thinned myometrium area with a solution of continuity between the gestational sac and the bladder.
Figure 6
Figure 6
Gestational sac visible through myometrial anterior aspect.
Figure 7
Figure 7
Section of hysterectomy with ectopic pregnancy.
Figure 8
Figure 8
Management of CSEP; LPS: Laparoscopy, LPT: Laparotomy HCG: BetahCG.
See this image and copyright information in PMC

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