EC Gynaecology

Caesarean scar ectopic pregnancy (CSEP) is a potentially catastrophic complication of caesarean section (CS) posing both diag- nostic and therapeutic challenges. Currently, there is no consensus on optimal management. We report the case of a 35-year-old patient who presented to our Early Pregnancy Assessment Unit at 9+4 weeks gestation with abdominal pain and brown vaginal discharge, on a background of one previous CS. Transvaginal ultrasound identified a gestational sac within the lower anterior uterine wall at the previous hysterotomy site. A minimally invasive surgical approach combining hysteroscopy and laparoscopy was utilized to confirm the diagnosis and commence management. Our technique was novel in that we administered diluted adrenaline into the scar site to minimize blood loss prior to performing transcervical suction curettage under laparoscopic guidance. Post-operatively a single dose of systemic methotrexate was given. β-hCG became undetectable by week five confirming successful treatment.

 Keywords: Caesarean Scar Ectopic Pregnancy (CSEP); Caesarean Section (CS); β-hCG

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