Ectopic pregnancy in a previous cesarean scar: a case report

Introduction: Ectopic pregnancy is the implantation of the blastocyst outside the endometrial cavity. Implantation of a pregnancy in the previous cesarean scar is considered the rarest presentation, accounting for 0.04% of cases. Diagnosis early in pregnancy is paramount for fertility preservation. Treatment in these cases may consist of methotrexate, laparoscopy or laparotomy in cases of hemodynamic instability. Objective: To report a rare case of ectopic pregnancy in a previous cesarean scar. Methodology: This is a descriptive observational study based on the analysis of the patient's medical record and literature review. Results: A 39-year-old woman, in her fourth pregnancy, the three previous deliveries being cesarean sections, and the last cesarean section 4 years ago, gestational age 7 weeks, comes to the service reporting pain in the cesarean scar. Denies bleeding or fluid loss. A transvaginal ultrasound was performed which showed a uterus in anteversoflexion, centered, with increased volume, containing gestational sac with low and anomalous implantation, with part inside the previous cesarean scar containing a single embryo with heartbeat present and rhythmic. Ectopic pregnancy in the isthmus region and partially within the myometrial part of the cesarean scar at 7 weeks and 2 days. Discussed with the patient and opted for termination of pregnancy, an exploratory laparotomy with segmental hysterotomy was performed in region of previous cesarean scar, removal of ovular remnants and uterine curettage and hysterorrhaphy. Sent for anatomopathology that confirmed placental fragments with chorionic villi of pattern compatible with the first trimester of pregnancy. Patient evolved well in the postoperative period and without complaints. Conclusion: This is a rare case and little described in the literature. The therapy used varies according to the classification of ectopic pregnancy. In our case, an approach little used in the literature was chosen, which presented a good outcome and rapid postoperative recovery for the patient.