Cesarean section scar ectopic pregnancy: a clinical case series.

Cesarean scar implantation represents a rare, though growing subset of potentially life-threatening ectopic pregnancy. Because of the global increase in cesarean sections as well as the improved diagnostic abilities of transvaginal ultrasound, incidence rates have continued to rise since the first reported case in 1978. Uterine rupture and catastrophic hemorrhage can ensue when diagnosis is delayed. Additionally, a higher rate of concurrent trophoblastic myometrial invasion may increase the incidence of retained products of conception or post procedural bleeding. Endovaginal ultrasound has a reported sensitivity of 85 % for detection. In difficult cases, magnetic resonance imaging is often useful as a problem solving exam in confirming diagnostic suspicions and guiding therapeutic decisions. We present a series of five illustrative cases illustrating the range of clinical and imaging findings. Sommario La cicatrice da taglio cesareo rappresenta nella gravidanza ectopica una rara seppur crescente concausa potenzialmente pericolosa per la vita. L’aumento su scala globale della pratica del taglio cesareo, nonostante il supporto dell’applicazione dell’ecografia trans-vaginale sempre più precisa, ha visto crescere i tassi di incidenza a partire dal primo caso riportato nel 1978. Quando la diagnosi è tardiva ne può derivare la rottura dell’utero con conseguente grave emorragia. Inoltre, il verificarsi concomitante di invasione trofoblastica a livello del miometrio potrebbe aumentare l’incidenza dei residui da concepimento o delle emorragie post intervento. L’ecografia trans vaginale ha una capacità diagnostica dell’85 %. Nei casi più difficili, la RM è spesso utile come esame risolutore nel confermare i sospetti diagnostici e guidare quindi verso la terapia appropriata. Vi presentiamo 5 casi esemplificativi che illustrano la varietà di dati clinici ed imaging.

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