First‐trimester diagnosis of cesarean scar ectopic pregnancy

Abstract

Once considered extremely rare, implantation of a pregnancy within the scar of a previous cesarean section is becoming more common. In fact, its incidence is now higher than that of cervical ectopic pregnancies. We identified 5 cases of ectopic pregnancy implanted in a prior cesarean section scar at our institution since 2004. We outline the criteria for the first-trimester sonographic diagnosis of cesarean scar ectopic pregnancy, including a new sign of lower uterine segment ballooning, which has previously not been reported. Clinicians must have a heightened awareness of this serious and potentially fatal pregnancy complication.

Analysis of cases with cesarean scar pregnancy

“…Our experience is that it took relatively longer for β‐HCG to drop to a normal level and even longer time for complete mass absorption. On rare occasions, rupture of the scar and heavy bleeding may occur following medical treatment 16,23,24 . Therefore, a medical approach may be combined with UAE, minimizing such complications 10 …”

“…16 Our policy is to recommend prompt treatment of CSP once the correct diagnosis is made, but standardized management is still under investigation. 5,16 At present, the choice of treatment depends on the patient's clinical manifestations, b-HCG levels and doctor's clinical experience. There are two ways to treat CSP: surgically or conservatively.…”

“…On rare occasions, rupture of the scar and heavy bleeding may occur following medical treatment. 16,23,24 Therefore, a medical approach may be combined with UAE, minimizing such complications. 10 Blind dilatation and curettage should not be recommended for CSP because the gestational sac is usually located in the incision scar.…”

Outcome of Cesarean Scar Pregnancies Diagnosed Sonographically in the First Trimester

“…Cesarean scar implantation pregnancies are associated with a high risk of pregnancy loss and maternal morbidity 1 , 7 , 10 , 11 . The diagnosis of a cesarean scar pregnancy is made sonographically when the gestational sac is implanted eccentrically in the anterior lower uterine segment in the expected location of the cesarean scar, with a thin or absent layer of myometrium around the sac anteriorly 2 , 12 – 15 . The gestational sac is often surrounded by extensive vascularity.…”

Cesarean scar pregnancy – a new challenge for obstetricians

“…Laparotomy revealed the presence of gestational tissues in the recess of a cesarean section scar ( 6 ) . In practice, early detection of this phenomenon has become possible as ultrasound scans and transvaginal probes have been introduced to obstetric practice and imaging quality has improved ( 7 , 8 ) . Earlier, CSP in the first trimester was treated as spontaneous abortion, while in the second and third trimesters it led to hemorrhage or uterine rupture.…”