Cesarean scar pregnancy is  rare type of ectopic pregnancy,occurs when a blastocyst implants on previous Caesarean scar. The incidence of Caesarean scar ectopic has increased due to increased number of Caesarean deliveries ¹and  is associated with complications, such as uterine rupture, uncontrollable bleeding which may lead to hysterectomy and increased maternal morbidity and mortality and subsequent infertility.²Early diagnosis using ultrasonography helps in prompt management improving outcome by allowing preservation of future fertility and also prevents maternal morbidity and mortality. Magnetic Resonance Imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention.

CASE REPORT:- 

A 34-year-old woman, gravida 3, para 2, with a history of two previous cesarean sections and unsuccessful termination methods, presented with 10-week gestation and vaginal bleeding. Suspecting  a scar ectopic pregnancy, ultrasound examination was performed, suggested gestational sac measuring 25 x 15 mm with surrounding chorionic tissue, extending into the cervico isthmic junction at the scar area anteriorly. Color Doppler showed mild vascularity in chorionic tissue with absent cardiac activity suggestive of miscarriage.The patient was counseled and proceeded with Emergency laparotomy leading to the removal of conception products and meticulous uterine repair to ensure integrity preservation.

IMAGES SHOWING SCAR ECTOPIC

DISCUSSION:

Cesarean scar pregnancies represent less than 1% of all pregnancies;  the rate is  increasing due to the increasing cesarean sections.¹Expectant management of a viable scar pregnancy has significant risk of an emergency hysterectomy if the pregnancy progresses beyond the first trimester. In this case ,Patient was planned for laparotomy. Intraop-erative findings; soft and vascular mass seen at  site of previous scar. Incision was given over bulge and products of conception were gently removed and Tissue was sent for histopathological examination and diagnosis of Caesarean scar ectopic pregnancy was confirmed. Patient was followed up with serum Beta human Chorionic Gonadotropin (B-hCG) level, till B-HCG came to non-preg-nant level.

CONCLUSION:

Caesarean scar ectopic pregnancies can have very fatal and poor outcomes, including uterine rupture, massive hemorrhage and maternal death. Thus, it is important that early and accurate diagnosis of Caesarean scar pregnancy is obtained in order to avoid complications and preserve fertility.²

1. Fait G, Goyert G, Sanderson A, Pickens A Jr. Intramural pregnancy with foetal survival: case history and discussion of etiologic factors. Obstet Gynecol 1987 Sept;70(3 Pt 2):472-474. 2. Fylstra DL. Ectopic pregnancy within a caesarean scar: a review. Obstet Gynecol Surv 2002;57:537-543.