Viable Cesarean Scar Ectopic Pregnancy Diagnosed by Ultrasound and Managed Surgically: A Case Report

Cesarean scar ectopic pregnancy (CSEP) is a rare and potentially fatal form of ectopic gestation seen in a patient with a prior cesarean delivery, resulting in implantation of the fertilized ovum within the fibrous scar of the previous cesarean. We report a case of a 34-year-old female with a history of cesarean delivery who presented to the emergency department with complaints of lower abdominal pain and amenorrhea for nine weeks. Transabdominal ultrasound showed an empty uterine cavity and empty cervical canal, with a viable gestational sac implanted in the anterior lower uterine segment at the site of the previous cesarean scar. The patient underwent laparotomy with scar excision. Laparoscopy is not commonly utilized in our setting, as there is only one laparoscopic operating theater available, which is primarily used by general surgery; consequently, all gynecology and obstetrics procedures are performed through conventional open approaches. Surgical excision of the ectopic gestation was completed without intraoperative complications. This case reinforces the need for early recognition and surgical excision of viable CSEP in order to prevent disastrous complications like uterine rupture or massive hemorrhage. It also highlights the role that imaging plays in both diagnosis and surgical planning for patients who may want future reproductive opportunities.