Ectopic Pregnancy Within a Cesarean Delivery Scar

June 15, 2011

This is a confirmed case of scar ectopic pregnancy. Yesterday, I carried out this exam in an emergency room, without much time to perform an adequate sonogram, the patient did not feel good with “cramps” but no signs of bleeding.

 

Title of Images: Ectopic pregnancy within a cesarean delivery scar

Description of Images: This is a confirmed case of scar ectopic pregnancy. Yesterday, I carried out this exam in an emergency room, without much time to perform an adequate sonogram, the patient did not feel good with “cramps” but no signs of bleeding.

I took 5 pictures from the same case. Each photo explains my point of view to obstetrician. I'd liked to emphasize that it's not always possible to me include all structures of a gestational sac in a same view due to short time of exam, limitations of field of view, etc.

Photo1: please note that a gestational ectopic sac is in development in the anterior part of the lower uterine segment, and exist an absence of myometrium between the bladder wall and the gestational sac, thus, a scar ectopic pregnancy was suspected. The shape of gestational sac was regular, so I discard abortion in progress. The endometrium is thick by haematometrium.


Photo 2: live embryo of 10 mm crown-rump length (7/8 weeks) was visualized with cardiac activity.


Photo 3: a yolk sac.


Photo 4: an empty cervical canal, thus I discard a cervical pregnancy, understand me?
 

Photo 5: embryonic cardiac activity

Photo 6: gestational sac and its contents


The doubt of bicornuate uterus with a normal intrauterine pregnancy in the left horn was raised, but the patient had a normal uterus in a previous exam.

Paulo Pires Cegalla, M.D.

Add your comments to this interactive case study.