Introduction: Caesarean scar pregnancy is rare. A high index of suspicion is necessary to make the right diagnosis early. Clinical Picture: Two women, each with a history of 1 previous caesarean delivery, were initially diagnosed with spontaneous abortion in progress when ultrasonography scan revealed the gestational sac to be in the lower uterine cavity. Subsequent ultrasound scans showed that the gestational sac was actually in the anterior uterine wall at the level of the uterine isthmus. Treatment: Both women were managed successfully with intrasac methotrexate injection. Outcome: We report 2 cases of caesarean scar pregnancies mistaken for spontaneous abortions by experienced ultrasonographers. Conclusion: This highlights the difficulty in differentiating between these 2 diagnoses and the importance of having a high index of suspicion in women with risk factors.
A uterine scar pregnancy is a gestation separated from the endometrial cavity and completely surrounded by the myometrium and the fibrous tissue of the scar. The most probable mechanism through which this can occur is invasion of the myometrium through a microscopic tract. The tract is believed to develop from trauma from previous uterine surgeries like dilatation and curettage, myomectomy, metroplasty and caesarean section (Fig. 1).1-3
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