Successful Vaginal Delivery in a Woman with Previous Caesarean Scar Ectopic Pregnancy: A Case Report and Literature Review

Abstract

Suchana Dhital, Beena Subba, Abha Govind and Reeta Limbu Subba

Background: Caesarean scar implantation is a rare form of ectopic pregnancy. Subsequent pregnancies following CSP is usually associated with complications such as first or second trimester miscarriage, placenta previa or accreta causing life threatening haemorrhage, emergency hysterectomy and uterine rupture threatening lives of mother and fetus. Given the lack of consensus on treatment modalities of CSP and subsequent pregnancy, babies are usually delivered by caesarean section at term. We report on a case describing uncomplicated pregnancy course and successful vaginal delivery of a woman who had had caesarean scar ectopic pregnancy previously.

Case: We report on a case of 38 year old, Gravida 7 P2+4, who was diagnosed with a CSP in her 5th pregnancy and was managed by evacuation of caesarean scar ectopic pregnancy. She presented to us again on her 7th pregnancy in early pregnancy assessment unit (EPAU) at 7+6 weeks. As she had recurrent miscarriage, Aspirin, Tinzaparin and Cyclogest were started after dating scan. She also developed gestational diabetes, hence, Metformin and Insulin was initiated. She was induced with Dinoprostone at 37+3weeks of pregnancy. Labour was conducted under epidural analgesia and the fetus was continuously monitored throughout labour. Obstetric management was largely based upon current literature and professional experience as there are not sufficient relevant cases published in literature neither specific guideline for the management in subsequent pregnancy after CSP.

Results: A Healthy baby of birth weight 3.19kg was delivered without complications with second degree perineal tear.

Conclusion: Although, subsequent pregnancy following caesarean scar pregnancy is associated with significant morbidity at all stages of pregnancy, hence, is recommended to deliver women by caesarean section at term, this case demonstrates that vaginal delivery is an option with careful case selection, close monitoring and informed consent from patient.

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