Cesarean section scar ectopic pregnancy -a management dilemma: a case report

Abstract

Background: Cesarean section scar ectopic pregnancy is a rare complication of pregnancy
that has increased following the increasing number of cesarean sections. It is important to have
a high clinical suspicion in any patient who presents with first trimester bleeding and multiple
previous cesarean deliveries. This is important because a delay in diagnosis can lead to
increased maternal morbidity and mortality. Fortunately, the use of first-trimester ultrasound
imaging has led to a significant number of these pregnancies being diagnosed. Early diagnosis
leads to prompt management and improves the outcome by avoiding significant morbidity and
allowing preservation of future fertility.
Case Presentation: We report a case of a 34year-old patient who had a history of two previous
cesarean sections. She presented with twin viable cesarean section scar ectopic pregnancy that
was diagnosed on the basis of transvaginal ultrasound imaging, and managed successfully by
systemic and local (intrasac) Methotrexate. Due to timely diagnosis and management we were
able to avoid complications and were able to preserve her fertility.
Conclusion: It is important for clinicians and radiologists managing women with risk factors
for a scar ectopic pregnancy to maintain a high index of suspicion Failure to diagnose and
initiate prompt management may lead to uterine rupture, massive hemorrhage, and maternal
death.
Keywords:Cesarean scar ectopic pregnancy, Diagnostic challenge, Management