Herculean task of preserving uterus in a patient with highly vascular cesarean scar pregnancy, a case report and review of literature

Abstract Background Pregnancy at a cesarean scar presents a challenge to the treating obstetrician. Surgical intervention may be difficult due to the high vascularity associated with this condition. The interventional radiologists play a key role in such cases since embolization prior to surgery reduces intraoperative bleeding. Case presentation We report a middle-aged woman who presented with bleeding, and underwent dilatation and curettage initially for cesarean scar pregnancy. As symptoms persisted, cross-section imaging was done which confirmed cesarean scar mass with excess vascularity. Considering the high vascularity associated with higher grades of cesarean scar pregnancy, it was initially treated with uterine artery embolization followed by surgery, which minimized the stress placed upon the surgical field and the uterus was conserved. Conclusions Since cesarean sections are being done more often, the incidence of cesarean scar pregnancy is slowly rising. Imaging is essential for further grading and extent involved. The inadequacy of treatment may lead to incomplete excision, which will increase the vascularity of the mass, resulting in difficulty in removing it surgically in the future. Preoperative embolization reduces blood loss, thus preserving the uterus.