Sonographic diagnosis of ruptured scar of previous cesarean section with secondary intra-abdominal pregnancy

Ruptured scar of a previous caesarean section is an uncommon yet serious complication, frequently resulting in considerable morbidity and mortality. In certain instances, this rupture can lead to a secondary intra-abdominal pregnancy, a condition where the fetus is expelled from the uterine cavity following a scar rupture. The article details 5 cases that were treated in a tertiary care hospital observed over a period of 2 years from October 2022 to October 2024. The patients had previous history of cesarean deliveries and had clinical symptoms of vaginal bleeding and abdominal pain. Ultrasound findings consistently revealed the rupture of the previous cesarean section scar, along with evidence of a secondary intra-abdominal pregnancy characterized by a fetus located in the maternal abdominal cavity and associated complications such as fetal demise and hemoperitoneum. The cases were managed surgically on strong clinical suspicion and ultrasound findings, and clinical outcomes were documented. Emergency laparotomy was required, and maternal recovery was successful in all the cases. Ultrasound is an essential diagnostic tool for identifying ruptured cesarean section scars and secondary intra-abdominal pregnancies, allowing for timely intervention. Early detection through ultrasound improves maternal safety by facilitating timely surgical management. Further studies are needed to develop standardized management protocols for these rare but serious obstetric emergencies.