Scar ectopic pregnancy

Case contributed by Dr Garth Kruger

Presentation

Abdominal pain

Patient Data

Age: 30 years
Gender: Female

First presentation

Modality: Ultrasound

The initial study showed what appeared to be a possible gestational sac in the lower segment of the uterus. The radiologist recommended follow up and further  Beta hCG correlation.

First follow up scan

Modality: Ultrasound

If you look carefully at the images you will see the gestational sac is developing in the myometrium. The presumed gestational sac is larger on ultrasound and a yolk sac is present. The patient had further elevation of her Beta hCG levels. Her symptoms persisted. 

On the very early images the endometrial stripe is visible passing posterior to the developing gestational sac.

Second follow up in 12 days

Modality: Ultrasound

At the third study 12 days later a fetal pole was visible. M-mode tracing confirmed a fetal heartbeat. 

Case Discussion

A gravida 2 presents to the ED with lower abdominal pain. Previous C-section delivery. The patient has an elevated Beta hCG level. She is referred for imaging with a provisional diagnosis of ? ectopic pregnancy. This turned out to be an ectopic pregnancy in the surgical scar of a previous caesarian section. On real time imaging you could see the scar in the lower segment of the uterus and clearly visualise the sac in the scar itself. The pregnancy was terminated chemically.

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Case Information

rID: 21222
Case created: 11th Jan 2013
Last edited: 1st May 2016
System: Obstetrics
Inclusion in quiz mode: Included

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