EP21.36: A diagnostic conundrum: ruptured Caesarean scar ectopic pregnancy

Ectopic pregnancies occurring within a Caesarean section scar are exceedingly rare. Here, we present the case of a 27-year-old woman, G5P3L3A1, who underwent a previous Caesarean section a year prior and presented to the antenatal care clinic with complaints of abdominal pain and vaginal bleeding. At 16 weeks of gestation, she had undergone medical termination of pregnancy at a local clinic and remained hemodynamically stable. Initial ultrasound examination revealed heteroechoic material within the uterus with protrusion of contents through an anterior myometrial defect indicative of retained products of conception with scar dehiscence. The patient's presentation, characterised by hemodynamic stability, was discordant with the ultrasound findings. Consequently, magnetic resonance imaging (MRI) was performed to confirm the diagnosis, revealing a ruptured Caesarean scar ectopic pregnancy, with the protruding contents seemingly contained by the surrounding omentum, thereby contributing to the patient's hemodynamic stability. These findings were confirmed intraoperatively. This case underscores the crucial role of the omentum in mitigating the consequences of such ectopic pregnancies and maintaining hemodynamic stability. Thus, timely identification and effective management during the early stages of pregnancy can mitigate maternal morbidity and mortality associated with this rare condition. 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.