Caesarean scar pregnancy

The following ultrasound criteria may be used for the diagnosis of caesarean scar ectopic pregnancy: Empty uterine cavity, gestational sac or solid mass of trophoblast located anteriorly at the level of the internal os embedded at the site of the previous lower uterine segment caesarean section scar, thin or absent layer of myometrium between the gestational sac and the bladder, evidence of prominent trophoblastic / placental circulation on Doppler examination and empty endocervical canal (Elson CJ et al., 2016).

Management strategies include systemic methotrexate, ultrasound-guided KCl injection, curettage, hysteroscopic or laparoscopic evacuation or hysterectomy. Expectant management is not suggested (Ash A. et al., 2007).

caesarean scar pregnancy
The gestational sac implanted inside a previous caesarean scar. The uterus is anteverted and the scan is performed transvaginally.

Bibliography

  • Ash A, Smith A, Maxwell D. Caesarean scar pregnancy . BJOG 2007;114:253–263.
  • Elson CJ, Salim R, Potdar N, Chetty M, Ross JA, Kirk EJ on behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. BJOG 2016;. 123:e15–e55.

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