Cesarean Scar Ectopic Pregnancy

Background: Pregnancy developing at a cesarean scar site is the rarest form of ectopic pregnancy, with a prevalence of approximately one case per 2000 ectopic pregnancies. Its incidence is increasing in parallel with the rise in primary and repeat cesarean sections. The use of first-trimester ultrasound imaging has led to early diagnosis and management of many such pregnancies. Case Report: We report the case of a 35-year-old female, gravida 3 para 1, with one living child and one previous abortion, who presented with one and a half months of amenorrhea and a history of cesarean section. MRI of the pelvis confirmed a cesarean scar pregnancy. Her initial ß-HCG level was 50,539 mIU/mL. She was treated with methotrexate and folinic acid on alternate days for a total of four doses each. Despite treatment, her ß-HCG levels increased to 57,257 mIU/mL. Consequently, she underwent a laparotomy for gestational sac evacuation followed by a tubectomy. Conclusion: Cesarean scar ectopic pregnancy, the rarest form of ectopic pregnancy, implants within the myometrium at the site of a previous cesarean section scar. It should be considered as a differential diagnosis for any pregnant woman with a history of cesarean section. Early diagnosis can often lead to successful medical management, but some cases may require surgical intervention.