Caesarian scar ectopic pregnancies

Non tubal ectopic pregnancy, such as caesarian scar ectopic or interstitial tube where the tube passes through the muscle of the uterus, the cervix and more rarely in the wall of the uterus itself (myometrial), often cause problems quite late on and are associated with a disproportionate number of serious complications.

One type of ectopic pregnancy that we seem to be seeing increasingly is where the pregnancy is implanted in the scar left in the uterus following a caesarean section. The evidence suggests that these pregnancies, if they continue, will be associated with the placenta becoming deeply implanted into the scar and often through the scar into the space between the uterus and the bladder. If the pregnancy survives, the placenta then fails to come away at delivery and there is a very high risk of severe bleeding, needing a hysterectomy to control bleeding or worse. Early in the pregnancy these scar pregnancies may also bleed heavily.

In view of these serious problems, if a scar pregnancy is diagnosed a patient will usually be advised that the pregnancy should not continue (though often it will fail in any event and may consist of only placental tissue). For the pregnant women this is a terribly difficult situation. As doctors we tend to talk about “treating or managing” caesarean section ectopic pregnancy, for the women it does not feel like that at all.

The optimal way to treat these is not established as there are no good comparative studies to be guided by. In the UK a consensus seems to be developing based largely on the experience of Professor Davor Jurkovic and his group at UCL in London. If diagnosed very early, then similar surgery to when we treat a miscarriage is safe. This involves introducing a small suction catheter into the womb and removing the pregnancy (which is usually only placental tissue that is growing). This is usually carried out under ultrasound guidance under an anasethetic in the operating theatre.

If you need any support or advice regarding the diagnosis or treatment of an ectopic pregnancy please email us at ept@ectopic.org.uk or call 020 7096 1838 and we will put you in touch with clinical specialists who would be happy to offer a point of view.

Ultrasound scan of a scar ectopic pregnancy
Ultrasound scan of a scar ectopic pregnancy