Caesarean Scar Ectopic Pregnancy, a case report and literature review

Background and Aim : Caesarean Section (CS) surgery rates are increasing over the last decade. Thereare concerns about CS surgeries that high rates of CS may increase maternal risks affecting futurepregnancies.The exact prevalence of caesarean scar defects is still unclear. however, it is related withincreasing rates of CS surgeries. Ectopic pregnancies are considered about 2% of all pregnancies.Cesareanscar ectopic pregnancy has a high rate of morbidity.Methods : CASE PRESENTATIONResults : A 34 years old woman(G4P3L3) with a history of 2 times cesarean deliveries, and a gestationalage(GS) of 6 weeks and 4 days based on her last menstrual period, due to vaginal bleeding continued fortwo weeks, presented with a cervical ectopic pregnancy reported in sonography. Physical exam was onlynotable for spotting and a closed cervix on speculum evaluation. Ultrasonography demonstrated a single 7weeks gestational sac located just adjacent the internal os suggesting cervical ectopic pregnancy. Butbecause of normal cervical length , there was a high suspicion for Caesarean scar ectopic pregnancy,so 3Dsonographyand MRI of abdomen and pelvis with contrast performed and revealed a GS implanted in priorscar of pregnancy with no support of myometrium.According to MRI that no myometrial tissue was overthe GS and high probabity of future percretta or ruptured uterus,so termination of pregnancy wasplanned.For treatment, at first, 3cc of KCl 15% solution was injected into the GS under ultrasonographyguide with close cardiac monitoring. Then Methotrexate with 2 dose protocol was injected alongside serialmeasurement of serum β-HCG levels. At last, the patient underwent an ultrasonography-guided curettagein order to remove pregnancy tissues from uterine.Conclusion : We encountered a 34 years old woman with an Ectopic Pregnancy located in scar of herprevious Caesarean surgeries. Caesarean scar ectopic pregnancy is uncommon, but requires immediateattention due to its costly mortalities and morbidities

Keywords:

Cesarean Section , Obstetrics , Pregnancy , Ectopic , Repeat , Cicatrix