Caesarean scar ectopic pregnancy with endogenous growth managed by ultrasound-guided dilatation and evacuation: a case report

Caesarean scar ectopic pregnancy is a rare but potentially life-threatening form of ectopic pregnancy, the incidence of which is rising in parallel with increasing caesarean delivery rates worldwide. Early diagnosis and timely management are essential to prevent severe maternal morbidity, in­clu­ding catastrophic hemorrhage, uterine rupture and loss of future fertility. We report the case of a 28-year-old wo­man with a history of a previous caesarean section who pre­sen­ted in early pregnancy and was diagnosed with a cae­sa­rean scar ectopic pregnancy exhibiting endogenous growth. Transvaginal ultrasonography demonstrated a ges­ta­tio­nal sac implanted in the anterior lower uterine seg­ment at the caesarean scar site, with a visible yolk sac, an empty uterine cavity, a thin residual myometrium mea­su­ring 0.6 cm and markedly elevated serum β-human cho­rio­nic gonadotropin (β-hCG) levels (>15,000 IU/L). After ap­pro­priate counseling and multidisciplinary evaluation, the patient underwent ultrasound-guided dilatation and eva­cua­tion without hysteroscopic assistance. The procedure was completed without complications. Post-procedure trans­va­gi­nal ultrasonography confirmed the complete re­so­lu­tion of the gestational sac, an empty endometrial ca­vity and improvement in residual myometrial thickness. The patient remained clinically stable, being discharged with the advice for serial β-hCG monitoring and follow-up imaging. This case highlights the critical role of early so­no­gra­phic diagnosis in caesarean scar ectopic pregnancy and demonstrates that, in carefully selected patients with en­do­ge­nous caesarean scar ectopic pregnancy, ultrasound-gui­ded dilatation and evacuation can be a safe, effective and fertility-preserving management option.