Authors: Saima Najam , Sumaiyya Ejaz Malik , Shehla Aqeel , Nida Rizwan , Ali Raza Haider

Abstract

Ectopic pregnancy is a pregnancy in which blastocyst is implanted at a site other than the endometrium. When it is partially or completely implanted with in the scar it is known as caesarean scar ectopic pregnancy (CSP). It is a very rare form of the ectopic pregnancy and most of the literature available is in the form of case reports and case series. In the succeeding report of a case, a 31 years old gravida-4 para-2 with one miscarriage and one caesarean section presented in emergency department with the amenorrhea of 9 weeks and 5 days. She had moderate abdominal pain and vaginal bleeding. After in-patient evaluation she 
was diagnosed of having viable CSP, necessitating termination of pregnancy. The challenge after the diagnosis was to remove the CSP and retain future fertility without increasing the morbidity. Uterine artery embolization (UAE) followed by the laparotomy and excision of the ectopic pregnancy was carried out to reduce the risk of the hemorrhage. Early and accurate diagnosis is the key and should be followed by individualized prompt treatment in expert hands. A multidisciplinary approach is essential to reduce the overall morbidity and help retaining the future fertility of the patient.

Keywords: Cesarean scar pregnancy (CSP), Uterine artery embolization (UAE), Hemorrhage, Ectopic pregnancy.