Cesarean scar ectopic pregnancy

Case contributed by Dr Seamus O'Flaherty

Presentation

Positive pregnancy test.

Patient Data

Age: 35 years
Gender: Female
Ultrasound

Transabdominal and transvaginal ultrasound scans have been performed. The uterus is anteverted. 

A live intrauterine pregnancy is identified. The gestational sac has an unusual morphology (tear drop) and appears to infiltrate into the anterior-inferior myometrium where there is evidence of a Cesarean scar. 

The gestational sac also overlies the internal cervical os. An area of fluid superior to the gestational sac likely represents fluid within the uterine cavity at the level of the fundus. 

Foetal heart rate is measured at 166 bpm. Gestational sac diameter and crown-rump length give estimated gestational age of 7 weeks + 5 days. 

Case Discussion

Cesarean scar ectopic pregnancy is a rare type of abnormal implantation. It is often considered the rarest type of ectopic pregnancy, although some do not include it in this category as implantation occurs within the uterus.

This patient had three prior live pregnancies delivered by cesarean. On this occasion the gestational sac implanted at the cesarean scar and trophoblastic tissue grew through the thickness of the myometrium, as seen on the ultrasound. Notice the unusual morphology of the low-lying gestational sac, which has a tear-drop appearance on longitudinal view.

The pregnancy was terminated due to the risk of uterine rupture if the pregnancy were to progress any further.

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