Uterine Scar Ectopic Pregnancy – A Rare Case of Misdiagnosis Reflecting Changes in Contemporary Obstetric Practice

Abstract

Caesarean scar and cervical ectopic pregnancies are rare but life-threatening complications of early pregnancy. Diagnosis may be difficult, particularly in discerning one from the other, as both may share early clinical and ultrasonographic features. Although treatment strategies are similar at the early stage of management, pathways of care soon diverge, which means the correct diagnosis is crucial to ensure the most appropriate decisions for ongoing decision-making. We present a caesarean scar ectopic case, initially diagnosed as early cervical pregnancy. The case highlights the difficulty that may confound the critical distinction between these two early presentations of pregnancy complication. It goes on to describe successful management using single dose systemic methotrexate despite variance with standard treatment protocols. Finally, we present a hypothesis to explain why diagnostic ambiguity may relate to current trends of best obstetric practice.