Lower Segment Cesarean Scar Pregnancy: A Cause of Uterine Rupture in the First Trimester

Cesarean scar pregnancy is a rare variant of ectopic pregnancy where the fertilized ovum gets implanted in the myometrium of the previous cesarean scar. The incidence of CSP among ectopic pregnancies is 6.1% and it is seen in approximately 1 in 2000 normal pregnancies.As trophoblastic invasion of the myometrium can result in uterine rupture and catastrophic hemorrhage termination of pregnancy is the treatment of choice if diagnosed in the first trimester. Expectant treatment has a poor prognosis and may lead to uterine rupture which may require hysterectomy and subsequent loss of fertility. We present a case report of a 24year old femaleG2P1L1with ruptured cesarean scar pregnancy who underwent emergency laparotomy and subsequently hysterectomy. In this case report, we aim to discuss ruptured cesarean scar pregnancy as obstetric emergency and methods by which we can make an early diagnosis that can be managed appropriately as to prevent maternal morbidity and mortality.

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First trimester uterine rupture previous lower segment cesarean scar

The Journal of Obstetrics and Gynecology of India ◽

10.1007/s13224-011-0010-2 ◽

2011 ◽

Vol 61 (1) ◽

pp. 88-89

Author(s):

Nita Visariya ◽

C. N. Purandare ◽

Vidya Bandukwalla ◽

Nikhil Purandare

Keyword(s):

Uterine Rupture ◽

First Trimester ◽

Lower Segment ◽

Cesarean Scar

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Cesarean scar pregnancy is associated with abnormal implantation but not macroscopic myometrial invasion in early first trimester of pregnancy

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.24790 ◽

2021 ◽

Author(s):

F. D'Antonio ◽

G. Cali ◽

J. Palacios‐Jaraquemada ◽

A. Khalil ◽

I. E. Timor‐Tritsch

Keyword(s):

Myometrial Invasion ◽

First Trimester ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

First Trimester Of Pregnancy

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Surgical management of first‐trimester heterotopic dichorionic diamniotic Cesarean scar pregnancy

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.24830 ◽

2021 ◽

Author(s):

E. Krispin ◽

M. A. Belfort ◽

A. A. Shamshirsaz

Keyword(s):

Surgical Management ◽

First Trimester ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar

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A Consequence of Cesarean Delivery: First-Trimester Cesarean Scar Pregnancy

First-Trimester Ultrasound ◽

10.1007/978-3-319-20203-7_17 ◽

2016 ◽

pp. 299-325

Author(s):

Ilan E. Timor-Tritsch ◽

Ana Monteagudo ◽

Terri-Ann Bennett

Keyword(s):

Cesarean Delivery ◽

First Trimester ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar

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Cesarean scar pregnancy associated with an impending uterine rupture diagnosed with 3-dimensional ultrasonography

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2017.02.023 ◽

2017 ◽

Vol 216 (5) ◽

pp. 531.e1-531.e2 ◽

Cited By ~ 2

Author(s):

Sa Ra Lee ◽

Soo Yeon Park ◽

Mi Hye Park

Keyword(s):

Uterine Rupture ◽

Cesarean Scar Pregnancy ◽

3 Dimensional ◽

Cesarean Scar

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Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1344 ◽

2015 ◽

Vol 7 (3) ◽

pp. 143-147

Author(s):

Santhosh Joseph ◽

Gonnabaktula Naga Vasanthalakshmi ◽

Usha Vishwanath ◽

M Anitha

Keyword(s):

Uterine Rupture ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Combined Treatment ◽

Successful Management ◽

Artery Embolization ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Dilatation And Curettage ◽

Future Fertility

ABSTRACT Cesarean scar pregnancy (CSP) is the rarest type of ectopic pregnancy implanted in the myometrium at the site of the previous cesarean section scar. It may lead catastrophic complications like uterine rupture and uncontrollable hemorrhage.4 Early diagnosis can offer treatment options of avoiding uterine rupture and hemorrhage, thus, preserving the uterus and future fertility. The conservative treatment can be by local and/or systemic administration of methotrexate, dilatation and curettage, excision of trophoblastic tissues (laparoscopy/laparotomy), bilateral internal artery ligation with trophoblastic evacuation and uterine artery embolization7 combined with curettage and/ or methotrexate. We did successful treatment of a viable CSP by systemic injections of methotrexate followed by selective uterine artery embolization in combination with dilatation and curettage. How to cite this article Mehta P, Vishwanath U, Joseph S, Anitha M. Successful Management of a Scary Case of Cesarean Scar Pregnancy with Combined Treatment using Methotrexate, Uterine Artery Embolization and Suction Evacuation. J South Asian Feder Obst Gynae 2015;7(3):143-147.

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