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Case Series
Ectopic pregnancy with implanted gestational sac in the cesarean scar
1 Doctor, Postgraduate in Radiology and Diagnostic Imaging, Ciências Médicas/FELUMA, Belo Horizonte - Minas Gerais, Brazil
2 Radiologist of Rede Mater Dei de Saúde, Belo Horizonte - Minas Gerais, Brazil
3 Medical Student at Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte - Minas Gerais, Brazil
4 Coordinator of the Human Reproduction course at Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte - Minas Gerais, Brazil; President of Fundação Hospitalar São Francisco de Assis, Belo Horizonte - Minas Gerais, Brazil
Address correspondence to:
Mariana Couto de Moraes
94, José Brandão Street, Belo Horizonte - MG 30640-020,
Brazil
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Article ID: 101382Z01MM2023
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de Moraes MC, Diniz RLFC, Ramos LFM, Diniz EF, Taitson PF. Ectopic pregnancy with implanted gestational sac in the cesarean scar. Int J Case Rep Images 2023;14(1):52–56.ABSTRACT
Introduction: Implantation of a pregnancy in the cesarean scar is considered a rarest presentation of ectopic pregnancy with high morbidity and mortality. The use of imaging tests is capable of early diagnosing such cases and assisting in the management of pregnancy. The present article reports two cases of ectopic pregnancy in the cesarean scar, illustrating the main aspects in ultrasound tomography (UST) and magnetic resonance imaging (MRI) exams. In addition, a bibliographic search was carried out in a database that presented data about this clinical condition.
Case Series: Case 1: A 44-year-old patient, without comorbidities, G2P1cA0, with a pregnancy of 9w4d, admitted with bleeding for 03 days. Ultrasound tomography showed a single gestational sac with an embryo of anomalous morphology, with no heartbeat and in isthmic topography, in an exophytic position, over the topography of a scar from a previous cesarean section. The initial diagnosis was placental accreta. After MRI of the pelvis, an ectopic pregnancy with a gestational sac implanted in the cesarean section scar (type II—exogenous), with signs of trophoblast/placental accreta. Case 2: A 30-year-old patient, without comorbidities, G2P1c, with a 7w3d pregnancy, with abdominal pain. Ultrasound tomography showed a single gestational sac with a gestational sac implanted in the cesarean section scar, transmural type I (endogenous), which was later confirmed by pelvic MRI.
Conclusion: It is necessary to highlight the importance of early diagnosis of ectopic pregnancy with implantation in a cesarean scar, given the possibility of making an appropriate therapeutic decision depending on the clinical context, aiming to reduce the possible complications of the condition.
Keywords: Cesarean section scar, Ectopic pregnancy, Magnetic resonance imaging, Transvaginal ultrasound
SUPPORTING INFORMATION
Author Contributions
Mariana Couto de Moraes - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Renata Lopes Furletti Caldeira Diniz - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Laura Filgueiras Mourão Ramos - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Enzo Furletti Diniz - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Paulo Franco Taitson - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Mariana Couto de Moraes et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
