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Reminder of important clinical lesson
Caesarean scar pregnancy
  1. Yves Jacquemyn1,
  2. Mieke Kerremans2,
  3. Bart Op de Beeck2,
  4. Cecile Colpaert2
  1. 1Obstetrics Department, UZA, Edegem, Belgium
  2. 2UZA, Edegem, Belgium
  1. Correspondence to Professor Yves Jacquemyn, yves.jacquemyn{at}uza.be

https://doi.org/10.1136/bcr.11.2011.5163

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    Summary

    Faced with difficulty discriminating between placenta and myometrium in a patient with three previous caesarean sections, MRI provided definitive diagnosis of caesarean scar pregnancy, allowing for a save and uneventful planned surgical procedure.

    Background

    When in doubt of the exact gestational location on first trimester ultrasound, in patients with a previous caesarean section, MRI can help define the exact location.

    Case presentation

    A G4P3, aged 31 years, with three previous caesarean sections for fetopelvic disproportion presented at 9 weeks amenorrhoea with an unplanned pregnancy. Transvaginal ultrasound demonstrated a viable 9 week embryo, there was doubt about the atypical aspect of the placenta: no clear distinction between placenta and myometrium was possible, neither in gray scale nor with colour Doppler imaging (figures 1 and 2). Differential diagnosis included placenta percreta and caesarean scar pregnancy. Abdominal obesity made further transabdominal ultrasound unfeasible. MRI was performed which showed an embryo with the gestational sac at the site of the caesarean scar (ventral side of the uterine corpus …

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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.