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ECTOPIC PREGNANCY IN CAESAREAN SECTION SCAR: A CASE REPORT AND LITERATURE REVIEW.

Almazrooei Khamis
Pathology - Journal of the RCPA: February 2015
doi: 10.1097/01.PAT.0000461471.82053.ed
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Introduction: Ectopic pregnancy developing in a previous Caesarean section scar is rare with few cases reported in the literature. The ectopic location is associated with abnormal placental adherence (placenta increta/percreta) and the risk of life threatening uterine rupture and haemorrhage.

Case report: The mother was a 32-year-old, gravida 3 para 2, with history of a previous lower uterine segment caesarean section (LUCS) delivery for placenta praevia. She presented at 8 weeks gestation with abdominal pain. Transvaginal ultrasound revealed an ectopic pregnancy in lower uterine segment with placenta extending into the LUSCS scar and large haematoma in the fundal cavity. The patient was deemed not suitable for conservative management and underwent total hysterectomy.

Pathology: Gross examination revealed a large haematometra, an intact gestational sac containing an embryo bulging into cavity of lower uterine body and placental tissue that extended deeply into isthmic myometrium to abut the anterior isthmic serosa. Microscopy showed implantation site in the lower isthmus and deep placenta increta/virtual percreta with deficient decidua basalis.

Discussion: The pathogenesis of this condition is not established but may relate to the conceptus entering the myometrium through a microscopic dehiscent tract created as a result previous trauma such as LUCS.

References

1. Maymon R, Halperin R, Mendlovic S, et al. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 2004; 19: 278-84.

2. Sadeghi H, Rutherford T, Rackow BW, et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol 2010; 27: 111-20.

3. Jurkovic, Hillaby K, Woelfer B, et al. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003; 21: 220-7.

(C) 2015 Royal College of Pathologists of Australasia