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Evolution of a cesarean scar pregnancy into a placenta accreta at term: A case report

Rachel V. Elep, MD and Maria Anna Luisa F. Dalawangbayan, MD, FPOGS
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines-Manila

This is a case report of a first trimester cesarean scar pregnancy (CSP) evolving into a placenta accreta at term based on the ultrasound imaging. The gestational sac, initially implanted at the site of previous scar, grew into the uterine cavity as the pregnancy progressed and resulted into a viable birth complicated by placenta accreta.

Cesarean scar pregnancy is a rare form of ectopic pregnancy and is associated with increased maternal morbidity and mortality. Thus, early recognition of the salient sonographic findings is crucial because a delay could lead to a life threatening condition. Early diagnosis also gives women the option to choose between expectant management and termination of pregnancy. The exact incidence of CSP has not been determined but its incidence is on the rise in parallel with the high rate of cesarean sections. There are two types of CSP. The first type is due to the implantation of the gestational sac on the scar with progression towards the uterine cavity. In this type expectant management is justifiable since pregnancy may progress into a viable pregnancy. The second type involves growth of gestational tissues towards the bladder and abdominal cavity and is associated with uterine rupture if immediate intervention is not undertaken. In this report, we present a case of a first trimester CSP that was managed expectantly and developed into placenta accreta at term.

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