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A second trimester caesarean scar pregnancy.

Pooja Sikka1, Vanita Suri2, Seema Chopra2

  • 1Post Graduate Institute of Medical Education and Research, Chandigarh, India ; Department of Obstetrics and Gynaecology, PGIMER, Chandigarh 160012, India.

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Caesarean scar pregnancy, a rare condition where the fetus implants on a prior C-section scar, can be successfully treated. This case study details a successful conservative management approach, preserving the uterus.

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Area of Science:

  • Reproductive Medicine
  • Maternal-Fetal Medicine
  • Gynecologic Surgery

Background:

  • Caesarean scar pregnancy is a rare but serious complication of previous Cesarean deliveries.
  • Implantation within the myometrium of a prior uterine scar presents unique diagnostic and management challenges.
  • Early diagnosis is crucial to prevent severe maternal morbidity, including uterine rupture and hemorrhage.

Purpose of the Study:

  • To report a case of advanced second-trimester Caesarean scar pregnancy.
  • To describe a multimodal management strategy involving medical, interventional radiology, and surgical approaches.
  • To highlight the successful conservative management of Caesarean scar pregnancy, avoiding hysterectomy.

Main Methods:

  • A second-trimester Caesarean scar pregnancy was diagnosed.
  • Treatment involved a combination of methotrexate administration and uterine artery embolization.
  • Subsequent hysterotomy was performed for definitive removal of the conceptus.
  • Uterine preservation was the primary surgical goal.

Main Results:

  • The combined treatment effectively managed the Caesarean scar pregnancy.
  • Hysterotomy allowed for the removal of the ectopic pregnancy while conserving the uterus.
  • The patient recovered without the need for a hysterectomy.
  • This approach demonstrates the feasibility of fertility-sparing management.

Conclusions:

  • Conservative management of advanced Caesarean scar pregnancy is achievable.
  • A multimodal approach combining methotrexate, uterine artery embolization, and hysterotomy can be successful.
  • Preserving uterine integrity is possible in selected cases of Caesarean scar pregnancy, avoiding hysterectomy and maintaining reproductive potential.