Critical Diagnosis and Management of a Case of a Partial Molar Cesarean Scar Ectopic Pregnancy

The objective of this case report is to highlight critical findings of a cesarean scar partial molar ectopic pregnancy and review the counseling and management strategies. A 43-year-old G3P0201 patient with a history of two cesarean deliveries at 10 weeks 3 days by last menstrual period presented to the ED with a week of dark brown discharge. The patient had previously been diagnosed with a pregnancy of uncertain viability five weeks prior at an outside institution but was lost to follow-up. Transvaginal ultrasound and pelvic computed tomography were performed to guide counseling and recommendations for the management of what was concerning for both a partial molar pregnancy and a cesarean scar ectopic pregnancy (CSEP). After counseling, the patient underwent a gravid total abdominal hysterectomy and bilateral salpingectomy for definitive management of the CSEP, as she had satisfied her fertility goals. Pathology of the specimen confirmed a partial molar pregnancy in the cesarean scar without evidence of an accreta. Close review of early pregnancy imaging is critical in making a diagnosis of a caesarean scar ectopic pregnancy complicated by a molar pregnancy. A gravid hysterectomy may reduce the morbidity of this combination of rare pregnancy pathologies.