Transactions of the Sixty-Fourth Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists
Ectopic pregnancy within a cesarean delivery scar: A case report

Presented at the Annual Meeting of the South Atlantic Association of Obstetricians and Gynecologists, St Petersburg, Fla, January 27-30, 2002.
https://doi.org/10.1067/mob.2002.125998Get rights and content

Abstract

The implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations. If it is diagnosed early, treatment options are capable of preserving the uterus and subsequent fertility. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. (Am J Obstet Gynecol 2002;187:302-4.)

Section snippets

Case report

A 24-year-old woman (gravida 5, para 4) came to the Medical University of South Carolina Hospital emergency department after 7 weeks of amenorrhea with the acute onset of light vaginal bleeding and mild cramping lower abdominal pain. This woman's obstetric history was remarkable for four previous early third-trimester preterm deliveries; the last two deliveries were by cesarean birth. Physical examination was remarkable only for mild lower abdominal tenderness to deep palpation, a small amount

Comment

Endometrial and myometrial disruption or scarring can predispose to abnormal pregnancy implantation. Implantation of a pregnancy within the uterine scar of a previous cesarean delivery is different from an intrauterine pregnancy with placenta accreta. Cesarean scar implantation is a gestation that is surrounded completely by myometrium and the fibrous tissue of the scar, and is separated from the endometrial cavity or fallopian tube. The mechanism that most probably explains scar implantation,

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Reprint requests: Donald L. Fylstra, MD, Department of Obstetrics and Gynecology, Medical University of South Carolina, CSB 634F, 96 Jonathan Lucas St, Charleston, SC 29425. E-mail: [email protected]

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