EP21.25: Pregnancy implanted on Caesarean scar: diagnosis and management

Scar pregnancy is a rare form of pregnancy characterised by the implantation of a fertilised egg into the uterine muscle or fibrous scar tissue resulting from a previous Caesarean section. It is a high-risk condition characterised by potential life-threatening complications, and considerations regarding the impact on fertility. This study aims to investigate the significance of endovaginal ultrasound as both a diagnostic and management tool in cases of scar pregnancies. We conducted a descriptive, retrospective, single-centre study at the obstetrics and gynecology department of Kairouan over a four-year period from January 2016 to December 2020. The study included 12 cases. The average age of patients in the study was 32.9 years. The mean values for gestivity and parity were 3.64 and 2.18, respectively. The average number of previous Caesarean sections among the patients was 1.45. The majority of cases (86%) were diagnosed at 10 weeks. The positive diagnosis was made using endovaginal ultrasound coupled with the suprapubic route. Methotrexate administered intramuscularly was the option chosen in 75% (9) of the cases. Two patients underwent aspiration under ultrasound guidance. Another patient underwent a subtotal hysterectomy at 13 weeks, with suspicions of placenta accreta. The duration of hospital stay was significantly longer for patients treated with IM methotrexate with no aspiration. The average duration for the negativation of β-hCG is 6.3 weeks. These results highlights the gravity of scar pregnancy, the necessity for early diagnosis by ultrasound, and the importance of seeking care from experienced healthcare teams.