Misdiagnosed Scar Ectopic Pregnancy: From Suction Evacuation to Laparoscopic Excision – A Case Report

Abstract

Scar ectopic pregnancy, a rare form of ectopic pregnancy, is implanted in the myometrium at the site of a previous cesarean section scar. With the increasing rate of cesarean deliveries, the incidence of cesarean scar ectopic pregnancies has been increasing. It is the implantation of blastocyst in the uterine scar of previous cesarean delivery. Scar ectopic pregnancies are challenging to diagnose, especially in the early stages. On ultrasound, they may appear similar to normal intrauterine pregnancies or other types of ectopic pregnancies. The lack of specific symptoms and signs further complicates the diagnosis. The proximity of the gestational sac to the cesarean scar should have raised suspicion, but the subtle differences were overlooked. Early and accurate diagnosis of scar ectopic pregnancy is critical to prevent complications such as severe hemorrhage, uterine rupture, and potential loss of fertility. Advanced imaging techniques, like magnetic resonance imaging, can provide more detailed information about the exact location and extent of the ectopic pregnancy, aiding in accurate diagnosis. This article explores a case where a scar ectopic pregnancy was misdiagnosed as a missed abortion, underwent suction evacuation, and was ultimately treated with laparoscopic scar ectopic excision 2 months later. The index case underscores the importance of high clinical suspicion, multimodal imaging, and timely surgical intervention in managing atypical postabortion bleeding and cesarean scar ectopic pregnancies.