ECTOPIC PREGNANCY IN SCARS FROM PREVIOUS CESAREA

A SERIES OF CASES

Abstract

Introduction: Ectopic pregnancy in cesarean section scar (EGCC) consists of implantation of a blastocyst in the myometrium of a scar from a previous cesarean section. The inci-dence of GECC has been increasing in parallel with the increase in cesarean sec-tions and currently ranges from 1:1800 to 1:2216 pregnancies. Objective: To report a series of cases and their outcomes, to know the sonographic characteristics that corroborate the diagnosis and to identify the associated major complications, to dis-cuss the forms of treatment and to report the evolution after the resolution of the condition. Method: Case series. Discussion: The best therapeutic proposal in cases of GECC is the interruption of pregnancy in the first trimester to prevent the fearful complications inherent to the myometrial implantation of the fetus (hemorrhage and uterine rupture). Expectant management is inadvisable and is associated with ex-ceptionally high morbidity and mortality. The patient profiles of the cases fit the risk factors cited in the studies. All cases had a previous cesarean section and a diag-nosis of ectopic pregnancy in a cesarean scar; mean age: 31.25 years (29-33 years); average parity (gesta): 3 (G5-G2). In this way, we meet what the literature cites as the main risk factors. In cases 1 and 3, patients were treated through ultra-sound-guided uterine evacuation associated with drug treatment. Case 2 received drug treatment with methotrexate through an intramuscular dose and later, added to the intra-gestational sac injection of the drug. And in case 3, the patient received drug treatment and, after bleeding, underwent surgical treatment with a diagnosis of placental accreta through hysteroscopy. In all cases, the patients were diagnosed early, amenable to conservative treatment and had their fertility preserved. Final considerations: A good approach to ectopic pregnancy in cesarean scar after early diagnosis with USG and Doppler performed by an experienced team has the power to change the patient’s prognosis and reproductive future.