Diagnostic challenges of ultrasound diagnosis of uterine scar pregnancy after cesarean section: a clinical case

DOI: 10.47026/2413-4864-2026-3-55-61

UDC: 618.31-073.43
BBC: 57.162.1

Dobrenkaya G.S., Dobrenkaya E.M.

Diagnostic challenges of ultrasound diagnosis of uterine scar pregnancy after cesarean section: a clinical case

Keywords: uterine scar pregnancy, cesarean section, ectopic pregnancy, frozen pregnancy, ultrasound diagnosis, human chorionic gonadotropin, differential diagnosis, bleeding, hysteroscopy, hysterectomy

An increase in the frequency of cesarean section is accompanied by an increase in the number of complications of subsequent pregnancies, including implantation of the fetal egg in the area of the postoperative scar. Despite availability of ultrasound imaging, an atypical course can lead to diagnostic errors and serious consequences. A clinical case of probable pregnancy in the area of a postoperative scar is described, the diagnosis of which was accompanied by difficulties during ultrasound examination. The clinical data of a 32-year-old patient, the results of dynamic determination of human chorionic gonadotropin levels and a series of ultrasound examinations of the pelvic organs are presented. A differential diagnosis was performed between incomplete spontaneous miscarriage, remnants of the gestational sac and ectopic uterine scar pregnancy after cesarean section. The primary ultrasound examination visualized the gestational sac in the uterine fundus. Subsequently, bloody discharge, absence of an embryo's heartbeat and a decrease in human chorionic gonadotropin were noted. During the control examination, the gestational sac was not detected in the uterine cavity, however, a small area of heterogeneous echostructure was visualized in the projection of the scar, which made it possible to suspect ectopic localization. Due to suspected ectopic implantation, an attempt of organ–preserving treatment – hysteroresectoscopy – was performed. During the intervention, massive bleeding developed, requiring laparotomy supravaginal amputation of the uterus without appendages. Suspected pregnancy in the area of the postoperative scar requires an early and targeted ultrasound assessment. A decrease in human chorionic gonadotropin in the presence of a mass in the scar area should be alarming in relation to ectopic implantation. Delaying specialized treatment increases the risk of life-threatening bleeding.

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About authors

Dobrenkaya Galina S.: Candidate of Medical Sciences, Ultrasound Diagnostician, Obstetrician-Gynecologist, Salutem Medical Center LLC; Associate Professor, Department of Radiation Diagnostics, Astrakhan State Medical University, Russia, Astrakhan (galeria@list.ru; )

Dobrenkaya Ekaterina M.: Candidate of Medical Sciences, Radiologist, Department of Remote Consultative Center for Radiation Diagnostics, JSC K 31 CITY; Acting Head of the Department of Radiation Diagnostics, Astrakhan State Medical University, Russia, Astrakhan (em.dobrenkaya@mail.ru; )

Article link

Dobrenkaya G.S., Dobrenkaya E.M. Diagnostic challenges of ultrasound diagnosis of uterine scar pregnancy after cesarean section: a clinical case [Electronic resource] // Acta medica Eurasica. – 2026. – №3. P. 55-61. – URL: https://acta-medica-eurasica.ru/en/single/2026/3/7/. DOI: 10.47026/2413-4864-2026-3-55-61.

Single article

Dobrenkaya G.S., Dobrenkaya E.M.