Ectopic pregnancy in a cesare an scar: a case study

Abstract

Objective: Toreport the case of a multiparous pregnant woman who developed uterine rupture secondary to an ectopic pregnancy implanted in a previous cesarean scar, emphasizing the severity of the condition and the diagnostic challenges of this rare condition. Case details: A 38-year-old multiparous patient in her fourth pregnancy was admitted to the emergency department with sudden and severe abdominal pain, associated with clinical and laboratory signs of hemorrhagic shock. Initial evaluation revealed severe anemia and the presence of free fluid in the abdominal cavity on FAST ultrasound. Given the hemodynamic instability, an emergency exploratory laparotomy was indicated, which revealed uterine rupture in the anterior retrovesical wall, resulting from an ectopic pregnancy in a previous cesarean scar, with massive intraperitoneal hemorrhage estimated at approximately 3000 mL. Subtotal hysterectomy was performed to control bleeding, associated with volume replacement and blood transfusion. The patient required intensive care in the immediate postoperative period, showing progressive clinical recovery and being discharged from the hospital in good general condition. Final considerations: Ectopic pregnancy in a cesarean scar is a rare, potentially fatal condition that requires a high degree of clinical suspicion. Early recognition and timely surgical intervention are essential to reduce maternal morbidity and mortality.