This case report describes a caesarean scar ectopic pregnancy in a 28-year old woman with two previous caesarean deliveries. Ultrasound found the gestational sac located in the lower uterine segment within the region of the previous caesarean scar. 3D imaging confirmed these findings. The differential diagnosis considered cervical ectopic pregnancy and missed abortion but color Doppler showed peripheral flow around the sac, confirming a caesarean scar ectopic pregnancy. Early detection of caesarean scar ectopic pregnancies by ultrasound is important to reduce risks of complications like hemorrhage which can require emergency hysterectomy.

1. DR.GEETA SHAH
DR.ARATI JOSHI
CASE REPORT
CAESAREAN SCAR
ECTOPIC PREGNANCY

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

3. 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).

4. 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.

5. 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

6. 3D- MULTIPLANAR IMAGING
CONFIRMS THE FINDINGS

7. 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

8. 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

9. DIFFERENTIAL DIAGNOSIS
Products of conception/embryo can be seen within the dilated
cervical canal as well as below the internal os.
3.INEVITABLE ABORTION

10. COLOURDOPPLERHELPSTODIFFERENTIATE
LSCS SCAR PREGNANCY MISSED ABORTION
Peri-trophoblastic flow is seen
in Caesarean scar pregnancy.
No Flow is seen around the
sac in missed abortion.

11.  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

12. 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

13. 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.

14. 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.

15. 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.

16. THANK YOU