Caesarian Scar Pregnancy

A 37 year old lady with a month old pregancy, came for a routine scan to confirm the status of the pregnancy. The first scan in a pregnancy is done to confirm the pregnacy, to localise the pregnacy (ie its placement- whether its is normally implanted or otherwise) , to check the age of the pregancy and to see if the cardiac activity of the embryo is recordable. On ultrasound , the pregnancy was seen to be within the uterus, but in the scar area of previous cesarian section. The upper cavity and cervical canal were empty. There was thinning of the scar myometrium. There was a fetus with near normal cardiac activity within the pregnancy gestational sac.

A cesarian scar pregnacy is very rare, though its incidence seems to be rising. It occurs due to poor healing of the cesarian scar tissue. If the pregnancy is allowed to progress, it may result in bleeding and even rupture of the uterus. This particular patient was managed by injecting potasium chloride into the growing fetus. Thus the fetal cardiac activity stopped. The pregnancy gestational sac gradually stopped growing too. Cesarian scar pregnancy cannot be terminated by the routine D and C (dilatation and curettage) method alone due to the risk of uterine rupture.