Lower Segment Cesarean Scar Pregnancy: A Cause of Uterine Rupture in the First Trimester

Background: Implantation of pregnancy within a cesarean scar is considered to be the rarest form of ectopic pregnancy. These pregnancies are challenging to diagnose and carry with them a high risk of bleeding and uterine rupture, which can require hysterectomy. Case: A 32-year-old woman presented to the gynecology ward with a 9-week pregnancy along with complaints of pain in the abdomen, vomiting, and fainting attacks. She had undergone two lower segment cesarean deliveries earlier. Examination revealed a distended and tender abdomen with a closed cervix. Ultrasound showed an irregular gestation sac intramyometrially in the lower uterine segment, with free fluid in the peritoneal cavity. Laparotomy was performed due to scar rupture. At laparotomy, a rent was present on right side of lower segment cesarean scar. The gestational sac along with the placenta was removed on extending the opening. Results: A total abdominal hysterectomy was performed to control intractable hemorrhage, as the patient did not desire future children. The histopathology report of the hysterectomy specimen revealed chorionic villi and trophoblastic tissue in the lower uterine segment invading the myometrium. Conclusions: Early diagnosis is very important to avoid catastrophic hemorrhage and to avoid the need for surgery.