Caesarean scar ectopic pregnancy


  • T. Ramani Devi Department of Obstetrics and Gynecology, Ramakrishna Nursing Home and Janani Fertility Centre, Trichy, Tamil Nadu, India
  • T. Sweta Department of Obstetrics and Gynecology, Ramakrishna Nursing Home and Janani Fertility Centre, Trichy, Tamil Nadu, India
  • C. Archana Devi Department of Obstetrics and Gynecology, Ramakrishna Nursing Home and Janani Fertility Centre, Trichy, Tamil Nadu, India



Case report, Caesarean, Ectopic pregnancy scar, Women


Ectopic pregnancy is a common cause of mortality and morbidity among the women of reproductive age group. Tubal pregnancy is the commonest.  It can occur in cervix, ovaries, previous caesarean scar, interstitial portion of the tube and abdominal cavity. Here we report a case of caesarean scar ectopic pregnancy which was managed conservatively. 31 yrs old gravid 3 previous 1 LSCS and 1 tubal ectopic come for antenatal consultation at 35 days of gestation. UPT was Positive. USG showed no evidence of intra uterine sac. Repeat scan after 10 days showed a gestational sac at the lower uterine segment scar. Hence it was decided for conservative management, injection methotrexate 50 mgm X 2 doses given. This was followed by misoprost vaginal insertion. Since patient did not expel the sac, injection PG F2 alpha 125 mg x 2 doses were given. Patient expelled the products of conception partially. This was followed by hysteroscopic guided evacuation.Caesarean scar ectopic was reported in 1978. Early diagnosis is by TV USG / MRI. Early ectopic can be treated medically. In delayed diagnosis, laparoscopic excision of the scar has to be done. In rupture of the scar site ectopic pregnancy laparotomy is indicated. In the event of heavy bleeding, hysterectomy has to be done. After conservative management and excision of the scar, fertility is not altered. Caesarean section scar pregnancy is a rare form of ectopic pregnancy which can lead to life threatening complications leading to mortality and morbidity. Treatment has to be individualized according to the gestational age, haemodynamic stability and desire for future fertility.


Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 2004;10(6):515-23.

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114(3):253-63.

Guindi WEl, Alalfy M, Abasy A, Ellithy A, Nabil A, Abdalfatah O. A Report of Four Cases of Caesarean Scar Pregnancy in a Period of 24 Months. J Med Diagn Meth. 2013;2(121):2.

Nankali A, Ataee M, Shah-lazadeh H and Daeichin S. Surgical Management of the Caesarean Scar Ectopic Pregnancy: A Case Report. Case Reports in Obst and Gynaecol. 2013; 1-5.

Fylstra DL. Ectopic pregnancy within caesarean Scar: a review. Obset Gynecol Surv.2002;57(8):537-43.

Fatma MA and Ebtesam MF. Medical & Clinical Reviews MRI in Caesarean Scar Ectopic Pregnancy. iMedPub Journals. 2015;1:1-9.

Aich R, Solanki N, Kakadiya K, Bansal A, Joshi M and Nawale A. Ectopic Pregnancy in caesarean section scar: A case report. Radiology Case Reports. 2015;10(4):68-71.

Wang CB,Tseng CJ.Primary evacuation therapy for caesarean scar pregnancy:three new cases and review .Ultrasound Obstet Gynecol. 2006;27(2):222-6.

Rizk B, Holiday CP, Owens S, Abuzeid M. Cervical and Caesarean scar ectopic pregnancies: Diagnosis and management. Middle East Fertility Society Journal. 2013;118(2):67-73.

Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003;21(3):220-7.

Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J and Jurkovic D. Deficient lower-segment cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008:31(1):72-7.

Koplay M, Dogan NU, Sivri M, Erdogan H, Dogan S and Celik C. Ectopic Pregnancy in a Cesarean Section Scar: Successful Management Using Vacuum Aspiration under Laparoscopic Supervision Mini Review of Current Literature. Case Reports Surg.2016;4






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