Caesarean delivery scar pregnancy [CDSP]: A case report

Caesarean scar pregnancy is a rare form of ectopic pregnancy. It is a dangerous condition that can potentially lead to uterine rupture and severe haemorrhage or even a secondary abdominal pregnancy. If it progress further in pregnancy it is likely to present as placenta accrete/increta with a high morbidity and mortality. Its early diagnosis can be challenging, and the optimal treatment has not been determined. We report a case of an ectopic pregnancy in a caesarean section scar, which was initially misdiagnosed despite using ultrasound. Although the use of ultrasound in combination with serum levels of human chorionic gonadotrophin [hCG] in the diagnosis of ectopic pregnancy is well established, the diagnosis of a rare kind remains difficult. However, early diagnosis allows appropriate management planning to preserve uterine integrity and future fertility. The surgical treatment includes curettage, laparoscopy, laparotomy with hysterotomy and excision of the gestational mass. A medical approach with systemic and /or intralesional methotrexate application, oral mifepristone and possibly local injection of potassium chloride or tricosanthin has been proposed by itself, or combined with surgical procedures.