A case report of caesarean section scar pregnancy: novel approach to acute management

Abstract

Abstract Introduction: This case report presents the clinical journey of a 41-year-old woman who was diagnosed with caesarean section ectopic pregnancy, which is the rarest form of ectopic pregnancy, but who presented as an emergency because of default to planned management. Case presentation: A 41-year-old woman who had two previous caesarean sections at a 10-week period of amenorrhea presented to our hospital gynaecology clinic with mild abdominal pain without bleeding per vagina for five days. A transvaginal scan was performed, and a caesarean scar pregnancy was diagnosed. The diagnosis was explained to the patient, and scar ectopic removal either by hysteroscopy or laparoscopy was scheduled in two days. The patient did not undergo the procedure as scheduled but experienced severe abdominal pain and vaginal bleeding after four days. On examination, she was haemodynamically stable with a soft abdomen. The vaginal speculum showed period-like bleeding with an opened cervical os. A transvaginal scan revealed a caesarean section ectopic with a foetal pole and heartbeat. Since the cervical os was opened, successful suction curettage was performed. Beta hCG became undetectable 11 days after curettage. Conclusion: This case demonstrates the current knowledge of the application of transvaginal scanning for managing the acute presentation of caesarean scar pregnancy, and the correct application of minimally invasive appropriate tailor-made surgical procedures will provide cost -effective and safer outcomes for individual patients.