EP17.72: Caesarean scar pregnancy: a case report highlighting diagnosis and management

Caesarean scar pregnancy (CSP) is a rare iatrogenic entity, affecting 1/2,000 pregnancies. It represents about 6% of ectopic pregnancies in women with a previous Caesarean section. This situation must be distinguished from a spontaneous abortion in progress or a cervical pregnancy. The management of CSP is an unexplored clinical field and a standard protocol is still missing. The hysteroscopic removal of CS is an option. In this case report, we describe a 41-year-old woman with CSP diagnosed by transvaginal ultrasound on the emergency department 10 days after being previously treated as spontaneous abortion in progress with vaginal misoprostol in another institution. Transvaginal ultrasound showed an enlarged uterus, and a hypochoic structure at the isthmus overlying the Caesarean scar, compatible with a gestational sac, which presented yolk sac and an embryo with cardiac activity. The adnexa were normal. Hysteroscopic surgery was decided. The operative finding revealed a gestational sac in a Caesarean scar defect. The resection was performed using hysteroscopic scissors and grasping forceps. The gestational tissue was cut and it was completely removed. The Caesarean scar defect was inspected to ensure that there were no remaining tissue. Both the operative procedure and the postoperative period were uneventful and she was discharged on the 2nd day after the surgery. Her serum B-hCG level was 169mlU/mL 4 weeks later. An early and prompt diagnosis of CSP is essential. Hysteroscopic removal of CSP provides good prognosis and should be an option for CSP management. 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.