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Cesarean Scar Pregnancy in a 29 year-old Parturient
Abstract Number: T2C-7
Abstract Type: Case Report/Case Series
Cesarean scar pregnancy (CSP), a rare variant of an ectopic pregnancy, occurs when the products of conception become implanted in a previous Cesarean incision(1). It was first reported in a case report by Larsen and Solomon in 1978(2). With the increase in the prevalence of Cesarean deliveries (CD) and availability of various imaging modalities (ultrasound, MRI, CT) the incidence of CSP is rising. The timely diagnosis of CSP is critical as a delay can lead to severe maternal morbidity or mortality.
A 29-year-old G3P2 with two prior CD presented with abdominal pain and vaginal bleeding. Two weeks prior, she had been seen by the MFM service for decreasing hCG levels and abdominal pain. A transvaginal ultrasound taken at the time noted low implantation and concern for a morbidly adherent placenta. Her hCG level was 15,829. On admission, she was found to be hemodynamically stable despite being symptomatic for eight hours. In addition, a bimanual exam was remarkable for an incomplete abortion. hCG levels were found to be 705. An ultrasound performed illustrated a Cesarean ectopic pregnancy. She was evaluated and consented by the anesthesia team for a possible D&C. Due to concerns of possible perforation with instrumentation, the decision was made to manage her medically. She was given a bolus of LR, a dose of Methergine 200mg IM and transferred to the floor. Her management included serial hCGs and a transvaginal ultrasound which was remarkable for vascular trophoblastic tissue within the Cesarean section scar. With the products of conception passed, stable hemodynamics and down trending hCG levels of 213, she was subsequently discharged from the hospital after 48 hours. She followed up as an outpatient and was discharged once her hCG level was 8.
Cesarean scar pregnancies are becoming more common with the increasing rate of Cesarean deliveries. A clinical history, strong clinical suspicion, combined with imaging can help confirm the diagnosis of CSP. Once a diagnosis has been made, a myriad of treatments can be elicited. Although there is no set consensus for the treatment of CSP (medical vs. surgical), management decisions should be made based upon the clinical presentation of the mother and the skills of the provider(3).
1. BJHS 2017; 2(3)4:312-315
2. Oman Med Journal. 2017; 32(2):161-166
3. Indian Journal Case Reports. 2017; 3(2):108-110.
4. Korean J Obstet Gynecol. 2010 Oct;53(10):934-939.