Caesarean scar ectopic pregnancy

Caesarean scar ectopic pregnancy (CSEP) is a rare type of ectopic pregnancy that becomes implanted in a C-section scar. It is often considered the rarest type of ectopic pregnancy 5.

Epidemiology

It has an estimated incidence of ~1:1800-2200 pregnancies 2,3.  The overall incidence is however thought to be increasing 4.

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

Differential diagnosis

On ultrasound consider:


Ultrasound - obstetric

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