Caesarean Scar Ectopic: sonographic findings and management dilemmas

The last decade has seen an increase in caesarean section (CS) rates in Ireland and internationally with a concommitant rise in the incidence of caesarean scar ectopic. Greater awareness of the common sonographic presentations of caesarean scar ectopic at different gestational ages may improve detection rates and reduce morbidity (Timor-Tritsch et al, 2012). The prevalence of caesarean scar ectopics is thought to be 1 in 2000 pregnancies causing significant morbidity and mortality (Sieczko et al, 2014). Defined as implantation of the pregnancy within the scar, it is thought to occur due to a fistula devoloped between the scar and the endometrium.The potential for uterine rupture causing massive haemorrhage is caused by trophoblastic invasion from the implantation site without the supportive myometrium (Jungkman and Anderson, 2015). Four cases identifed in an Irish tertiary referal centre over 4 years demonstrate the differing presentations of caesarean scar ectopic and the management dilemmas discussed in the setting of Irish legislation in relation to termination of pregnancy.