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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.

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

Complications

Treatment and prognosis

Ultrasound-guided methotrexate injection emerges as the treatment of choice. Surgical or invasive techniques, including dilatation and curettage are not recommended for 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, these pregnancies.

Differential diagnosis

On ultrasound appearances consider:


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