Rare complications of cesarean scar
A 38-year-old gravida 3, para 2 with history of in vitro fertilization and a positive pregnancy test was admitted with vaginal spotting. The patient had undergone cesarean delivery 5 years ago. TAS revealed anteverted uterus with a 38-mm gestational sac, 5-mm yolk sac, and a live embryo with crown–rump length 13.3 mm corresponding to 7 weeks and 6 days in the lower uterine cavity at the scar site. TVS showed an empty endometrial cavity and endocervical canal. The gestational sac was implanted in the anterior myometrium with myometrial thinning (maximum thickness 5.2 mm) between the gestational sac and the urinary bladder [Figure and ]. The hypoechoic cesarean scar (CS) was visualized adjacent to the gestational sac. On Color Doppler USG, mild increased peritrophoblastic flow was seen around the sac. MRI confirmed the presence of a gestational sac in the lower uterine segment at the scar site, with very thin (4 mm) myometrium between the gestational sac and the urinary bladder. The endometrial cavity and endocervical canal were empty and were displaced by the gestational sac posteriorly []. However, no bladder invasion was seen. The medical termination was then performed with fetal intracardiac potassium chloride injection under USG guidance.