Management of a Viable Ectopic Pregnancy on Caesarean Scar After IVF-ET Procedure: A Case Presentation

To present the management of a viable ectopic pregnancy on caesarean scar following IVF-ET procedure. A 33-year old woman with gravida 2, parity 1 admitted to our outpatient clinic in her 8th weeks of gestation. She had a previous caesarean section 4 years ago. Transabdominal ultrasound examination revealed empty uterine cavity and cervical canal, but an intramural viable gestation near the cesarean scar. Laparotomy was performed. The gestational sac was bulging and thinning out the uterine wall anteriorly at the scar site. We evacuated the products of conception and repaired scar. After 2 hours from the operation an abundant vaginal bleeding occurred and an emergent relaparatomy performed. No active bleeding focus could be detected but bilateral uterine arteries were ligated. As a result, caesarean scar pregnancy is a highly complicated type of ectopic pregnancy and should be kept in mind during routine obstetric practice.

[1]  E. Çalışkan,et al.  Three‐dimensional ultrasonographic diagnosis and hysteroscopic management of a viable cesarean scar ectopic pregnancy , 2007, The journal of obstetrics and gynaecology research.

[2]  A. Smith,et al.  Caesarean scar pregnancy , 2007, BJOG : an international journal of obstetrics and gynaecology.

[3]  S. Haberman,et al.  Cesarean Scar Ectopic Pregnancies: Etiology, Diagnosis, and Management , 2006, Obstetrics and gynecology.

[4]  Chin-Jung Wang,et al.  Endoscopic management of cesarean scar pregnancy. , 2005, Fertility and sterility.

[5]  M. Arslan,et al.  Treatment of viable cesarean scar ectopic pregnancy with suction curettage , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[6]  T. Okai,et al.  Limitations of conservative treatment for repeat Cesarean scar pregnancy , 2005, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[7]  K. Seow,et al.  Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy , 2004, Acta obstetricia et gynecologica Scandinavica.

[8]  K. Hillaby,et al.  First‐trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar , 2003, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[9]  K. Miller,et al.  Ectopic pregnancy within a cesarean delivery scar: a case report. , 2002, American journal of obstetrics and gynecology.

[10]  Y. Soong,et al.  Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. , 1999, Human reproduction.

[11]  A. Herman,et al.  Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar , 1995, British journal of obstetrics and gynaecology.

[12]  C. Yan.  A report of four cases of caesarean scar pregnancy in a period of 12 months. , 2007, Hong Kong medical journal = Xianggang yi xue za zhi.

[13]  J. Legarth,et al.  Intramural pregnancy after in vitro fertilization and embryo transfer. , 1992, Fertility and sterility.

[14]  J. Larsen,et al.  Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report. , 1978, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.