Molar cesarean scar ectopic pregnancy: Report of 2 cases with review of literature

Abstract

Background: The occurrence of hydatidiform mole at the cesarean scar site is a rare problem. Few cases have been reported, thus there is not enough information for accurate diagnosis and management of this event. Case Presentation: Herein, we present 2 cases of an invasive hydatidiform mole embedded in cesarean scar tissue, one presented with occasional hypogastric pain and nausea and another with spotting both with a history of cesarean section. Transvaginal ultrasonography and a considerably high titer of beta-human chorionic gonadotropin blood test suggested the existence of molar pregnancy on the cesarean scar, which was confirmed through histological assessment. In the first case, evacuation of molar pregnancy followed by scar resection at the cesarean scar site led to successful fertility preservation management. Conclusion: The presence of abdominal pain and unexplained bleeding in a pregnant woman without gestational sac in ultrasonography, strongly suggests ectopic pregnancy. The process of diagnosis should be followed by definitive diagnostic evaluation, including beta-human chorionic gonadotropin titer measurement, ultrasonographic assessment (2 and 3-dimensional), magnetic resonance imaging, diagnostic laparoscopy, and finally biopsy of the lesion. Key words: Cesarean scar pregnancy, Ectopic pregnancy, Hydatidiform mole, Molar pregnancy.