EP21.47: Ectopic pregnancy in Caesarean scar: the combination of needle punctured sac and ultrasound‐guided suction aspiration

An ectopic pregnancy is characterised by the implantation of an embryo outside the uterine endometrium. Between 2015 and 2023,127 ectopic pregnancies were admitted to our department, corresponding to 0.73% of the pregnancies. Over the past eight years, 2 ectopic pregnancies were identified in Caesarean sections and 1 in the cervix. The presented case involves a 40-year-old woman, 3G2P1A, who was admitted to the emergency department with sudden abdominal pain and mild vaginal bleeding. She had 2 previous Caesarean sections. Upon admission, the patient was stable, speculum examination revealed moderate active bleeding, with an open cervical os. Transvaginal ultrasound showed an anteverted uterus with an endometrial thickening measuring 14-16mm, with gestational sac detected near the lower segment of the anterior uterus wall, with a fetal pool for 6 weeks and embryocardia. Blood tests revealed a hemoglobin of 13g/dL and b-hCG of 160000. At the end of the day, the patient was mostly asymptomatic. A sac rupture was performed using a Novak curette under abdominal ultrasound guidance. Following the procedure, the vaginal ultrasound revealed an overflow of the amniotic fluid into the uterine cavity. On the third day, an ultrasound guided aspiration was performed since a embryonic fragments were still present inside the uterine cavity. After three weeks post-discharge, b-hCG level was negative and vaginal ultrasound revealed an empty cavity. This case report aims to raise awareness to this complication, which can easily be mistaken for a low implantation uterine sac. To date, there is no preferred method to treat Caesarean section scar ectopic pregnancy. 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.