Ectopic twin pregnancy in cesarean scar after in vitro fertilization/embryo transfer: case report

Objective: To present two cases of ectopic twin pregnancy in a Cesarean section scar following IVF-embryo transfer. Design: Case report. Setting: Tertiary referral case center. Patient(s): Two women who had ectopic twin pregnancy in a Cesarean section scar, in both cases following IVF and embryo transfer. Intervention(s): Three-dimensional power Doppler ultrasound and diagnostic hysteroscopy were performed for early recognition and treatment. Main Outcome Measure(s): Prevention of pregnancy complications such as hemorrhage, uterine rupture, and preservation of fertility. Result(s): Case 1: diagnosis was made in a 31-year-old woman after IVF; she was managed with laparotomy excision of the twin pregnancy. Case 2: an early such pregnancy was diagnosed in a 37-year-old woman following IVF. She was treated successfully with hysteroscopy and laparoscopic surgery. Conclusion(s): Because ectopic pregnancy in a Cesarean scar carries high risk of uterine rupture and uncontrollable hemorrhage, such a twin pregnancy presumably carries similar risks. Focused application of high-resolution ultrasound and diagnostic hysteroscopy may help lead to early recognition of ectopic twin pregnancy in a Cesarean scar and prevention of complications such as hemorrhage and uterine rupture. (Fertil Steril (R) 2008;90:2009.e19-e21. (C)2008 by American Society for Reproductive Medicine.)