Heterotopic Cesarean Scar Pregnancy in Non-assisted Fertility: ACase Report

Introduction: Cesarean rate increased in recent decades worldwide. One of the consequences of the increased cesarean rate andrepeat cesarean is the significant increase in cesarean scar pregnancies (CSPs). Diagnosis of CSP is more difficult when there is aheterotopic pregnancy in non-assisted pregnancy.Case Presentation: The patient was 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini hospital, Sabzevar, Iran in2016. She had history of cesareans and abortions. Three ultrasounds were performed showing gestational sac in the lowersegment of the uterus with different diagnoses: 1) with hemorrhage over it, 2) with the 2nd gestational sac over it, which was diagnosedas missed abortion, and 3) with an echo-free and irregularly region supporting the 2nd sac or clot in the lower part of theuterus. The increased local vascularity suggested level of placenta accreta, partial mole, or trophoblastic reaction. Since the firstdiagnosis was missed abortion, curettage was performed. Due to the continuation of severe bleeding, abdominal hysterectomy wasperformed. The patient was discharged in good condition after days.Conclusions: Heterotopic CSP does not have any specific symptoms, which caused it to be easily misdiagnosed. Physicians shoulduse precise diagnostic tests in case of controversial test results.

Keywords:

Cesarean Section , Repeat , Ectopic Pregnancy , Twin Pregnancy , Uterine Rupture , Hysterectomy