Cesarean scar ectopic pregnancy
Updates to Article Attributes
Caesarean scar ectopic pregnancy (CSEP) is a rare type of abnormal implantation. It is often considered the rarest type of ectopic pregnancy, although some do not includedinclude it in this category as implantation occurs within the uterus.
Epidemiology
It has an estimated incidence of ~1:1800-2200 pregnancies 2,3. The overall incidence is however thought to be increasing 4, representing up to 6% of ectopic pregnancies in patients with a history of a Caesarean section 11.
Pathology
Poor healing can result in a focal thinning of the scar, which may be susceptible to implantation of the gestational sac at this point rather than in the endometrial cavity 10.
Radiographic features
Ultrasound
Described sonographic features include:
- empty uterus
- empty cervical canal
- development of the gestational sac in the anterior part of the lower uterine segment
- an absence of myometrium between the bladder wall and the gestational sac
Treatment and prognosis
Ultrasound-guided methotrexate injection has emerged as the treatment of choice. Surgical or invasive techniques, including dilatation and curettage are not recommended due to high morbidity and poor prognosis. Because subsequent pregnancies may also be complicated by uterine rupture, the uterine scar should be evaluated before, as well as during the subsequent pregnancies.
Complications
- uterine rupture
- massive haemorrhage
Differential diagnosis
On ultrasound consider:
- an anterior cervical ectopic pregnancy can have some similar features
- prominent C-section scar tissue
- miscarriage in progress.
-<p><strong>Caesarean scar ectopic pregnancy (CSEP)</strong> is a rare type of abnormal implantation. It is often considered the rarest type of <a title="Ectopic pregnancy" href="/articles/ectopic-pregnancy">ectopic pregnancy</a>, although some do not included it in this category as implantation occurs within the uterus.</p><h4>Epidemiology</h4><p>It has an estimated incidence of ~1:1800-2200 pregnancies <sup>2,3</sup>. The overall incidence is however thought to be increasing <sup>4</sup>, representing up to 6% of ectopic pregnancies in patients with a history of a Caesarean section <sup>11</sup>.</p><h4>Pathology</h4><p>Poor healing can result in a focal thinning of the scar, which may be susceptible to implantation of the <a href="/articles/gestational-sac">gestational sac</a> at this point rather than in the endometrial cavity <sup>10</sup>. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Described sonographic features include:</p><ul>- +<p><strong>Caesarean scar ectopic pregnancy (CSEP)</strong> is a rare type of abnormal implantation. It is often considered the rarest type of <a href="/articles/ectopic-pregnancy">ectopic pregnancy</a>, although some do not include it in this category as implantation occurs within the uterus.</p><h4>Epidemiology</h4><p>It has an estimated incidence of ~1:1800-2200 pregnancies <sup>2,3</sup>. The overall incidence is however thought to be increasing <sup>4</sup>, representing up to 6% of ectopic pregnancies in patients with a history of a Caesarean section <sup>11</sup>.</p><h4>Pathology</h4><p>Poor healing can result in a focal thinning of the scar, which may be susceptible to implantation of the <a href="/articles/gestational-sac">gestational sac</a> at this point rather than in the endometrial cavity <sup>10</sup>. </p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Described sonographic features include:</p><ul>
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