Ectopic Pregnancy Within a Cesarean Delivery Scar

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.

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