Cesarean scar pregnancy

Objective 

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy. Without proper treatment in time, CSP may cause major bleeding, uterine rupture, and other life-threatening complications. Here, it was aimed to present a case of CSP occurring in an adult woman and its management.

Case(s)

A 39-year-old G3P3 patient presented to our clinic with complaint of a delayed menses for 2 weeks. She stated that she had her previous deliveries with cesarean sections. The physical examination demonstrated that vagina and cervix were in normal appearance and bimanual vaginal examination revealed that cervical motions were painless. Transvaginal and suprapubic ultrasound revealed that the 6 week 3 days gestational sac with FHB according to CRL (crown-rump length) was implanted at the site of the previous cesarean section scar. The serum level of the β-hCG was 12388 mIU/ml and hemoglobin level was 12,2 g/dl. A diagnosis of a CSP was made with these findings. The patient was informed. Preoperative preparation of the patient was performed after obtaining the informed consent of her spouse. Dilation and curettage (D&C) was performed in the operating room. No complication occurred. The patient was discharged after postoperative 3rd hour.

Results 

CSP is one of the rarest forms of ectopic pregnancy, but incidence of CSP has been rising to be about 1/2000 normal pregnancies due to the increasing number of cesarean section deliveries. Treatment modalities of CSP include methotrexate administration (directly or systemically), wedge resection using either laparotomy or laparoscopy, Dilatation &Curettage, Curettage with a hysteroscopy and uterine artery embolization.

Conclusion

In the pregnancies of the patients with a history of uterine scar or scar pregnancy, new localizations of pregnancy should be determined earlier by using transvaginal ultrasound and cesarean scar pregnancy should be kept among the differential diagnoses of these risky pregnancies.

Keywords

Cesarean scar pregnancy, ectopic pregnancy.