EP21.12: A synchronous tubal and Caesarean scar ectopic pregnancy in a patient with an intrauterine device: a case report and literature review

Caesarean scar primary ectopic pregnancy (CSP) is rare, occurring in 1/1,800-1/2,500 pregnancies and making up 6% of ectopic pregnancies. CS scar + tubal pregnancy is even rarer, with only 2 reported cases and none with an IUD in place. This report highlights the diagnostic and management challenges posed by ectopic pregnancies, especially when occurring concurrently. It emphasises early diagnosis using transvaginal ultrasound and Doppler imaging in synchronous tubal and Caesarean Scar (CS Scar) ectopic pregnancies. A 34-year-old G4P2(2012) presented with vaginal bleeding, amenorrhea, and a positive pregnancy test. Diagnostic workup included transvaginal ultrasound and Doppler imaging, revealing a Copper-T IUD in place, a left tubal ectopic pregnancy, and a CS scar ectopic pregnancy (Type II-Exogenic Type). Surgical intervention included left salpingectomy, contralateral tubal ligation, and IUD removal. For the CS scar pregnancy, intramuscular Methotrexate therapy was given on day 1 post-surgery. A 15% decline of the serum B-HCg was noted on Day 4 until Day 14. Serum B-Hcg levels were normal on Day 21. Sonographic imaging demonstrated a CS scar niche. The rarity of synchronous tubal and CS Scar ectopic pregnancies in a current IUD user underscores the role of ultrasound imaging in its diagnosis and management. This case highlights the need for tailored care for a successful outcome. Management strategies, whether expectant, medical, or surgical, should be individualised based on patient characteristics and clinical presentation to optimise outcomes in cases of ectopic pregnancies. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.