Cesarean Scar Ectopic Pregnancy: A Case Report

Scarring uterus, after cesarean section, involves complications at distance and the most important are the abnormal location of the future pregnancy, more precisely, scar ectopic pregnancy, placenta previa or abnormally adherent placenta. Therefore, in patients with scarring uterus, the imaging of the location of pregnancy, placental insertion, and the risk of abnormal placentation is indicated. We report the case of a 42-year-old woman with a cesarean birth history (9 years ago), currently with six-week scar ectopic pregnancy. The ultrasound detected a gestational sac, located intrauterine, at the anterior wall at the isthmic portion, separated from endometrial cavity in previous caesarean scar, with a corresponding CRL of six weeks with cardiac activity. Treatment with Methotrexate 60 mg intramuscular (days 1, 3, 5) associated with calcium folinate 6 mg intramuscular (days 2, 4, 6) was initiated. Ultrasound exam after treatment detected the embryo without cardiac activity. The BHCG was down from 9226 mUI/ml to 107 mUI/ML. Conservative medical management was applied and 9 weeks later with the second period, it was ultrasound certified that the pregnancy was eliminated.