Role of imaging modalities in diagnosis of silent caesarean scar ectopic pregnancy after ovulation induction: a case report

Abstract

There has been an increased prevalence of ectopic pregnancies in the present scenario attributing to 1.5-2% of all pregnancies. Caesarean scar pregnancies are rare, occurring in approximately 1 in 2000 pregnancies, although the incidence is increasing. The increasing rate of caesarean scar ectopic pregnancies mirrors the increasing rate of caesarean delivery. Disruption of the endometrium and myometrium after caesarean delivery predisposes to improper implantation at the site of the prior hysterotomy. Without normal surrounding myometrium, untreated caesarean scar ectopic pregnancies can result in uterine rupture with severe maternal hemorrhage and death. Although ultrasound remains the primary imaging modality for this diagnosis, MRI may be useful in the setting of equivocal cases and also may aid in the detection of possible placental implantation or bladder wall invasion. An MRI may provide additional confirmation of the ultrasound findings and characterize the myometrial interface if the pregnancy is difficult to distinguish from other pregnancy complications such as a cervical ectopic pregnancy or consideration for expectant management of pregnancy is considered.