Cesarean Scar Pregnancy (CSP): A Case of Partial Scar Dehiscence in EarlyPregnancy

Abstract

Cesarean Scar pregnancy (CSP) is a type of ectopic pregnancy characterized by the implantation of the gestational sac
at the site of previous cesarean scar. A cesarean scar pregnancy is a complex iatrogenic pathology and life threatening
condition with a high risk of uterine rupture, massive vaginal bleeding and placenta accreta spectrum. Misdiagnosis is
not uncommon particularly after 7 weeks of gestation. Pregnancyneeds to be terminated once diagnosis is confirmed
in the first trimester to avoid serious complications, such as massive hemorrhage, uterine rupture and fatal outcomes.
Approximately 14% cases of CSP were misdiagnosed as interuterine pregnancy, missed miscarriage, inevitable
miscarriage or trophoblastic tumor. This case was presented multiple time with vague symptoms and misdiagnosed as
intrauterine pregnancy at 11+6 weeks , hemodynamically unstable with partial scar dehiscence and intraperitoneal
hemorrhage necessitating an exploratory laparotomy and massive blood transfusion.
Conclusion: The two mandatory essentials for the best clinical and administrative management of CSP are early
diagnosis and prompt referral to tertiary care centers. Clinically,a high index of suspicion is necessary in patients with
repeated presentations and non-specific symptoms to ensure timely diagnosis and intervention, minimizing the risk of
severe morbidity or mortality.