Cesarean Scar Ectopic Pregnancy: A Diagnostic and Management Challenge

Abstract

Cesarean section scar pregnancy is the rarest form of ectopic pregnancy. Cesarean scar ectopic pregnancy poses a diagnostic and management challenge, and if not diagnosed and adequately treated in early pregnancy, it may lead to considerable maternal morbidity or mortality. We describe the presentation, workup including radiology studies, and subsequent management plan of a cesarean scar ectopic pregnancy in a 34-year-old female with a history of four previous cesarean sections. We were successful in treating this rare form of ectopic pregnancy without any maternal morbidity with a combination of medical and surgical management.

Keywords: cesarean scar; ectopic pregnancy.

Figure 1. Transabdominal ultrasound showing 6 mm single small gestational sac with yolk sac of five weeks located in anterior part of lower uterine segment at cesarean scar, myometrium between bladder wall and gestational sac absent, and empty uterine cavity shown by red arrow.

Figure 2. MRI pelvis T2W FAT-SAT sagittal image showing empty gestational sac located in lower uterine segment partially attached to the previous cesarean (blue arrow) within the endometrium (yellow arrow). The myometrium between the sac and bladder wall appears very thin (red arrow). Bladder wall appears intact and smooth (green arrow).

T2W FAT-SAT, T2-weighted fat-saturation.