The pregnancy dating dilemma
However, many hypotheses have been proposed and one of them is that the conceptus enters into the myometrium through a microscopic tract between the prior caesarean scar and the endometrial canal.
Early detection and treatment is necessary to avoid complications like uterine rupture, maternal mortality or adverse impacts on future fertility due to hysterectomy.
Conclusion: Diagnosis of caesarean scar pregnancy is difficult, but transvaginal sonography and colour flow Doppler may be helpful.
Though the best and standard management is still unclear for this condition, the use of intracardiac KCl, and intra sac and placental Methotrexate can be considered in cases of viable caesarean scar pregnancy.
A 33 year old lady, G3P1L1A1 came to casualty at 8 weeks 3 days period of gestation with a transabdominal sonography reporting a suspected scar pregnancy.
The patient was discharged on day 5 without complications and advised to follow up with weekly serum β HCG reports.Diagnosis is difficult but transvaginal sonography and colour flow Doppler using the following criteria may be helpful.• Visualization of an empty uterine cavity as well as an empty endocervical canal • Detection of the placenta and/or a gestational sac embedded in the hysterotomy scar • A thin or absent myometrial layer between the gestational sac and the bladder • A closed and empty cervical canal • The presence of embryonic or fetal pole or yolk sac with or without cardiac activity • The presence of prominent or rich vascular pattern in the area of caesarean scar.One week after this procedure, serum β HCG dropped to 6691 m IU/ml and TVS showed residual products of conception in the previous sac site.Serum β HCG continued to show falling trend and normalized on day 84th (12 weeks) following treatment and TVS showed an empty endometrial cavity.