ABSTRACT

Due to the limited number of reported cesarean scar pregnancy cases, information concerning both the natural history and treatment are scarce. Decision to perform a conservative treatment should rely only on robust and evidence-based data. Mode of treatment of cesarean scar pregnancy is often related to the severity of symptoms, the serum levels of free-Beta-human chorionic gonadotrophin and the surgical experience. Delay in diagnosis may lead to serious maternal outcome due to hemorrhage and risk of ending up in emergency hysterectomy. This case report discusses a case of a rare cesarean scar pregnancy that was missed on initial presentation as patient was discharged after routine evacuation and presented to our outpatient one month after evacuation with large complex adnexal mass. Keeping high index of suspicion, we made a differential diagnosis of chronic ectopic pregnancy and planned exploratory laparotomy. Per operative findings confirmed a neglected case of cesarean scar pregnancy that has been ruptured into left broad ligament causing her pain and bleeding. High index of suspicion, thorough clinical judgment and individualized management with strict adherence to follow up can ensure good outcome.

Keywords:  Caesarean section, Ectopic pregnancy, Caesarean scar pregnancy, Ultrasound, Hysterectomy, Maternal morbidity.

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