Late-first-trimester cesarean section scar ectopic pregnancy with placenta increta: a case report.
BACKGROUND
Cesarean section scar pregnancy is a rare ectopic pregnancy that is difficult to manage due to high risk of uterine rupture and maternal hemorrhage-a risk that increases with gestational age.


METHODS
A 21-year-old, gravida 3 para 2 woman was diagnosed at 13.5 weeks' gestation by pelvic ultrasound and magnetic resonance imaging with a cesarean scar ectopic pregnancy and placenta increta. Surgical removal of the pregnancy via exploratory laparatomy with intraoperative use of vasopressin minimized initial blood loss. However, extraction of the placenta increta resulted in uncontrolled bleeding, requiring a supracervical hysterectomy.


CONCLUSIONS
This is the first case report, to our knowledge, of a late-first-trimester cesarean section scar ectopic pregnancy with placenta increta. Early identification of the ectopic pregnancy may allow for more conservative, nonsurgical management. However, with a more advanced gestational age and placenta increta, surgical management is most appropriate to minimize associated maternal risks. A transverse wedge resection of the implantation site, uterine artery embolization, uterine artery ligation, endovascular balloon catheters, or uterine artery tourniquet may help decrease bleeding during surgical extraction of the pregnancy and placenta increta, and also may prevent a hysterectomy.
Department of Obstetrics and Gynecology, INOVA Fairfax Hospital, Falls Church, VA, USA. overcash@gwu.edu
Rachael T
RT
Overcash
Zareh H
ZH
Khackician
D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010923:Placenta Previa / Q000000981:diagnostic imaging* / Q000601:surgery*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging* / Q000601:surgery*; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology / Q000601:surgery; D014599:Uterus / Q000473:pathology