Pregnancy and delivery after ectopic pregnancy in a caesarean section scar

Background/Aims: Ectopic pregnancy in a caesarean section scar is a rare and life-threatening complication of pregnancy. In a successive pregnancy there is a risk of repetition of the ectopic nidation and a risk of uterine scar rupture during pregnancy and labour. Delivery in a pregnancy subsequent to this kind of ectopic pregnancy is usually by primary caesarean section. Methods and Results: We report on a case of 10th week vital ectopic pregnancy in a caesarean section scar treated by suction evacuation of the uterine cavity under direct laparotomic control. Our patient subsequently became pregnant again and after an uncomplicated pregnancy she delivered her baby vaginally at her own request in the 39th week. Labour was conducted under epidural analgesia and the foetus was continually monitored: an anaesthesiologist remained in the Labour Ward throughout the labour. A healthy boy was delivered without complications. Digital as well as ultrasound investigation of the scar showed no dehiscence. Conclusion: This case demonstrates the possibility of maintaining fertility despite a previous ectopic pregnancy in a Caesarean section scar. While vaginal delivery in a subsequent pregnancy remains an option, this option should only be available under close monitoring and after full informed consent.