Diagnosis and Management of Cesarean Section Scar Pregnancy

Abstract

Abstract

Background: Cesarean scar pregnancy is a rare form of ectopic pregnancy and its incidence is on the rise during recent years. It cannot be diagnosed clinically and performing medical termination of pregnancy (MTP) without diagnosing it is life threatening. Difficulties are encountered in diagnosing even with ultrasonogram (USG) when pregnancy advances. Case: A 24-year fourth gravida with a history of one dilatation and curettage and two cesarean sections underwent MTP by the surgical method at 14 weeks of pregnancy. She had hemorrhagic shock due to excessive bleeding and had hematologic evidence of disseminated intravascular coagulation (DIC). She was initially diagnosed to be a case of incomplete abortion and was managed conservatively for 35 hours by giving blood and blood products. DIC was corrected and instrumental evacuation was attempted, during which time scar pregnancy was suspected and the same was confirmed by repeat USG. She was successfully treated with injection methotrexate. Conclusion: This case illustrates that it is mandatory to subject the patient to USG before performing termination of pregnancy. Every obstetrician should have the USG knowledge of diagnosing caesarean section (CS) scar pregnancy and must look for the implantation site during the early pregnancy scan in all cases with history of cesarean section. (J GYNECOL SURG 31:285)