Presentation of a Previous Cesarean Scar Ectopic Pregnancy with Hypovolemic Shock

The prevalence of ectopic pregnancy is 1 to 2% and a previous cesarean section scar ectopic pregnancy or hysterectomy occurs as rare as 1 per 2000 pregnancies. In the current case report, the authors introduced ectopic pregnancy in cesarean scar with unstable hemodynamic condition and surgical management to preserve uterus.

A 31-year-old pregnant female in the 9th week of pregnancy was admitted with vaginal bleeding and slight pain in the hypogastrium. The cesarean scar pregnancy was confirmed by sonography. In the course of hospitalization, due to the patient’s hemodynamic instability, the emergency laparotomy was performed. In the previous cesarean section scar, a 3 × 4 cm mass with a massive hematoma was found. It was removed and placental bed was sutured. Since the vaginal bleeding continued, the uterine artery ligation was carried out and due to severe bleeding, Foley catheters were packed inside the uterus. Two days later, the patient was discharged from the hospital in good general condition.

Despite the rarity of ectopic pregnancies in the previous cesarean section scars, paying attention and having this kind of pregnancy in mind can aid its early diagnosis and reduce possible morbidity and mortality including uterine rupture and severe bleeding, which can be considered as its irreversible complications.