A 28-year-old woman with a uterine scar from prior myomectomy presents at 8 weeks with bleeding. MRI shows a pregnancy implanted within the anterior uterine wall scar with no clear myometrial layer between it and the bladder. This is BEST classified as a:
- A Cervical ectopic pregnancy
- B Caesarean scar pregnancy (CSP) — intramural type ✓
- C Cornual ectopic pregnancy
- D Interstitial ectopic pregnancy
Explanation
Cesarean scar pregnancy (CSP) is classified into two types: Type 1 (endogenous) where the pregnancy grows toward the uterine cavity, and Type 2 (exogenous/intramural) where it grows through the scar into the myometrium toward the bladder, with no or minimal myometrium between it and the bladder. The patient had a myomectomy scar, not cesarean, but the principle applies — this is an intramural scar ectopic. The distinction matters because Type 2 CSP carries a much higher risk of uterine rupture, hemorrhage, and placenta percreta if it continues. Management includes systemic or local methotrexate, suction evacuation, or hysteroscopic excision depending on gestational age and type.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.