Ectopic pregnancy in previous Caesarean section scar

Hong SC, Lau MSK, Yam PKL
Correspondence: Dr Hong Sze Ching, hong_sze_ching@hotmail.com

ABSTRACT
We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility.

Keywords: Caesarean scar pregnancy, ectopic pregnancy, placenta praevia, placenta percreta, uterine rupture
Singapore Med J 2011; 52(6): e115-e117