Clinical Practice and Cases in Emergency Medicine

Introduction: Ectopic pregnancy is a serious pregnancy complication that occurs when a gestational sac implants outside the uterus, most commonly in the fallopian tubes. However, a rare form of ectopic pregnancy, the cesarean scar ectopic pregnancy, occurs within a prior cesarean section scar and is becoming more common as cesarean delivery rates continue to rise. Cesarean scar ectopic pregnancies are challenging to diagnose and pose significant risks, including rupture and hemorrhage, which can lead to maternal death.

Case Report: A 27-year-old woman presented to the emergency department with a 16-day history of abdominal pain and vaginal bleeding, initially believed to be her menstrual period. She had a history of one previous lower uterine segment cesarean section. On examination, her beta-human chorionic gonadotropin (β-hCG) levels were elevated, and transvaginal ultrasound revealed an empty uterus with a gestational sac within a cystic area of the cesarean scar. The patient was diagnosed with a cesarean scar ectopic pregnancy. Given the high rupture risk, she underwent laparoscopic surgery with dilation and curettage. Postoperative management included methotrexate, antibiotics, and analgesics. A follow-up β-hCG test showed a significant decline, confirming resolution of the ectopic pregnancy. At her two-week follow-up, the patient remained asymptomatic with no bleeding, and ultrasound confirmed no retained products of conception.

Conclusion: Cesarean scar ectopic pregnancies are a rare and life-threatening complication of pregnancy that require timely diagnosis and intervention. Early detection through transvaginal ultrasound and appropriate multidisciplinary management are critical to prevent adverse outcomes. This case highlights the importance of early recognition, classification, surgical decision-making, and standardized diagnostic protocols to improve outcomes and save lives