DR.GEETA SHAHDR.ARATI JOSHI

CASE REPORT CAESAREAN SCAR

ECTOPIC PREGNANCY

LOCATIONS OF ECTOPIC PREGNANCIES

Most common site - Fallopian tube (95%).Least common site - LSCS scar, cervix and abdomen (<1%).

CASE : LSCS SCAR PREGNANCY

28 yr. old woman G3 P2, came with H/O 7 weeks of amenorrhoea, pain and bleeding PV.

She had a past history of 2 caesarean deliveries, 5 years and 10 months ago respectively (UPT was positive).

ULTRASOUND FINDINGS

The uterus and cervical canal were empty.

G sac was seen in the anterior part of lower uterine segment in the region of previous LSCS scar.

There was absence of myometrium between

bladder wall and G.sac.

On detailed Transvaginal examination, a yolk sac and a live embryo with a CRL of 1.2 cm (corresponding to 7 weeks, 3 days) were seen.

ULTRASOUND FINDINGS

3D- MULTIPLANAR IMAGINGCONFIRMS THE FINDINGS

DIFFERENTIAL DIAGNOSIS

ULTRASOUND FINDINGS :

The Gestational sac is seen within the cervical canal and the myometrium is not thinned out as seen in LSCS scar pregnancy.

1.ANTERIOR CERVICAL ECTOPIC PREGNANCY

DIFFERENTIAL DIAGNOSIS

Sliding sign - The G sac of the abortus slides against the endocervical canal following gentle pressure by the probe. This is not seen in cervical pregnancy.

2. MISSED ABORTION

DIFFERENTIAL DIAGNOSIS

Products of conception/embryo can be seen within the dilated cervical canal as well as below the internal os.

3.INEVITABLE ABORTION

COLOUR DOPPLER HELPS TO DIFFERENTIATE

LSCS SCAR PREGNANCY MISSED ABORTION

Peri-trophoblastic flow is seen in Caesarean scar pregnancy.

No Flow is seen around the sac in missed abortion.

Caesarean scar pregnancy is a rare type of ectopic pregnancy ( 1:1800) and is a life threatening condition due to risk of severe haemorrhage.

A rising problem due to increasing number of Caesarean deliveries worldwide in the recent years .

It is believed to result from canalisation of the LSCS scar to the endometrial cavity creating a “niche” in which the pregnancy may implant.

DISCUSSION

RISK FACTORS FOR CAESAREAN SCAR PREGNANCY :

Multiple Caesarean deliveries.

Previous Dilatation and Curettage.

Previous abnormal placentation.

Uterine surgeries: myomectomy, metroplasty, hysteroscopy.

Previous manual removal of placenta.

DISCUSSION

COMPLICATIONS OF CAESAREAN SCAR PREGNANCY

Myometrial rupture - can lead to fatal outcome .

Massive secondary Postpartum haemorrhage due to scar dehiscence – may require emergency hysterectomy.

Abnormal placentations - Placenta Accreta , Percreta.

CONCLUSION

Early detection by Transvaginal USG can detect

Location of sac.

Abnormal placentation.

Allows more treatment options.

Reduces risk of complications.

Caesarean scar pregnancy is a rare diagnosis but should be considered in a patient with low lying G. sac and an appropriate surgical history.

REFERENCES

Caesarean scar pregnancy diagnosis, management and follow up -J ultrasound July 2013.

3D power doppler USG and conservative treatment of ectopic in caesarean section scar- Fertil Stertil 2007.

Caesarean scar pregnancy : issues in management -Ultrasound Obstret Gynecol 2004.

First trimester caesarean scar pregnancy evolving into placenta previa /accreta at term- J ultrasound med 2005.

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