Presentation
Low abdominal pain with a positive pregnancy test and history of cesarean section 3 years ago.
Patient Data
Empty proximal uterus, empty cervical canal. Gestational sac containing a fetal pole equivalent to 7 weeks gestational age with tiny cyst-like yolk sac and no cardiac activity. Normal decidual reaction.
This early pregnancy is eccentric in the anterior part of the lower uterine segment with a very thin overlying myometrium measuring 1.5mm from the bladder wall to the gestational sac.
Otherwise, the pelvic ultrasound was normal.
Case Discussion
Cesarean scar pregnancy is rare and is seen as an eccentric anterior gestation with thin overlying anterior myometrium in the lower uterine segment.
As there is no cardiac activity there is a low risk of complicating uterine rupture so we recommended follow-up in one week to confirm foetal demise.
Scar pregnancy can be differentiated from cervical ectopic pregnancy by location. Intrauterine abortion in progress has an irregular sac and transducer compression demonstrates a sliding motion because the sac is no longer implanted.
Case co-author: Dr Wafa Dhmran (obstetrician and gynecologist)
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