Rupture of a caesarean scar ectopic pregnancy: A case report

Abstract

Background Caesarean scar pregnancy is an uncommon form of ectopic pregnancy characterized by implantation into the site of a caesarean scar. Common clinical features include vaginal bleeding and abdominal pain; however, a significant proportion of cases are asymptomatic. The primary diagnostic modality is transvaginal ultrasound. There is no current consensus on best-practice management. Case presentation A 36-year-old woman, G7P2, presented to an early-pregnancy service with vaginal spotting and an ultrasound scan demonstrating a live caesarean scar ectopic pregnancy at 8 + 5 weeks' gestation. On examination she was hemodynamically stable with a soft abdomen. She was advised to have dilation and curettage (D&C) under ultrasound guidance; however, she was concerned that she might require more extensive surgery, such as a hysterectomy and so requested non-surgical management. On day 1 she underwent ultrasound-guided embryocide with lignocaine followed by inpatient multi-dose systemic methotrexate. Her beta-human gonadotrophic hormone level decreased. Repeat ultrasound on day 18 demonstrated a persistent caesarean scar ectopic pregnancy with increased vascularity, and so uterine artery embolization (UAE) was performed with a view to D&C the following day. This plan was altered to expectant management with ongoing follow-up by a different clinician who had had previous success with UAE alone. On day 35 the patient presented with life-threatening vaginal bleeding that required an emergency total abdominal hysterectomy. Conclusions Caesarean scar pregnancies are uncommon. Multiple treatment strategies have been employed, with variable degrees of success. Further research into risk stratification and management are needed to guide clinician and patient decision making.

Abortive Retroperitoneal Ectopic Pregnancy Followed Up by Ultrasound: A Case Report

“…Retroperitoneal ectopic pregnancies are extremely rare. REP is difficult to diagnose, while delays can lead to higher morbidity and mortality [6][7][8][9]. Most ectopic pregnancies have a history of ectopic tubal pregnancy or ectopic tubal surgery and in vitro fertilization [10].…”

Caesarean Scar Ectopic Pregnancy

“…The exact incidence of CSEP is unknown. It is estimated to occur in 0.05-0.4% (1 in 1800 to 1 in 2500) of all pregnancies [1]. A recent publication from the UK's Early Pregnancy Surveillance Service (UKEPSS) reported an estimated incidence of 1.5 per 10,000 maternities [7].…”

“…CSEP is one of the rarest forms of ectopic pregnancies [1][2][3][4][5]. However, in the last two to three decades, an increasing number of case reports and case series have been published [4].…”

“…The pregnancy is surrounded by the myometrium and the fibrous tissue of the scar. It usually manifests with painless vaginal bleeding and often misdiagnosed as spontaneous miscarriage or cervical ectopic pregnancy [1,4]. A misdiagnosis or a late diagnosis of CSEP can result in early uterine rupture with life-threatening maternal haemorrhage leading to hysterectomy and loss of reproductive potential [6].…”

A rare case of caesarean scar ectopic pregnancy: a case report

“…2 The incidence of scar ectopic pregnancy is 1 in 2000. 3 This entity is rare but its incidence is rising due to the increasing rates of caesarean deliveries. 4 Scar ectopic pregnancy is caused by endometrial and myometrial disruption due to previous caesarean section.…”