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Cesarean scar ectopic pregnancy

Case contributed by Dr Nurliyana Izyan

Presentation

G3P2 at 17 weeks gestational age. She had 2 previous uncomplicated cesarean deliveries. MRI for an abnormal ultrasound.

Patient Data

Age: 30 years
Gender: Female

MRI images show a single fetus in a horizontal lie. The fetal sac is located in the inferior aspect of the uterus. The placenta is adjacent to the cervix and located inferoposterior to the fetal sac. The previous cesarean scar is at the anteroinferior aspect of uterus, which is demonstrated as a linear hyperintense signal on T2WI. The endometrial cavity is displaced anteriorly by the sac and the posterior lower myometrial wall is thin suggestive of invasion. 

Case Discussion

Abdominal ultrasound was suggestive of a cesarean scar ectopic pregnancy. On MRI, there is an acute angulation of the myometrium at the superior aspect of the sac, which mimics a septated uterus. During surgery, a hysterectomy was performed due to the morbidly adherent placenta and severe hemorrhage. Patient had a stormy postoperative period but was discharged well. Histopathological examination confirmed a cesarean scar ectopic pregnancy with a morbidly adherent placenta.

Case contributed with Dr Nyazirah Ab Wahab.

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