Cesarean Scar Ectopic Pregnancy
A 47 years old pregnant female presented in the Emergency Unit with pelvic pain that had started in the last 24 hours. From her medical history we highlight that she underwent two C-sections and a salpingectomy due to a pregnancy located in the fallopian tube. At the ultrasound examination a cesarean scar ectopic pregnancy is revealed (Figure 1), for which we opted to perform an uterine arterial embolization (figure 2). We note the decrease in dimensions and the favorable evolution in Figure 3.
Pregnancy located in the scar from a cesarean birth is located outside the uterine cavity and is completely surrounded by myometrium and fibrous tissue of the scar in the prior low uterine segment(1). Invasion of the myometrium in the first trimester may lead to uterine rupture and intense bleeding as the pregnancy advances. This type of pregnancy is often misdiagnosed as a cervical or aborting pregnancy(2).
Murray, Heather, et al. "Diagnosis and treatment of ectopic pregnancy." Cmaj 173.8 (2005): 905-912.
Rotas, Michael A., Shoshana Haberman, and Michael Levgur. "Cesarean scar ectopic pregnancies: etiology, diagnosis, and management." Obstetrics & Gynecology 107.6 (2006): 1373-1381.