Successful Vaginal Delivery in a Woman with Previous Caesarean Scar Ectopic Pregnancy: A Case Report and Literature Review

Background: Caesarean scar implantation is a rare form of ectopic pregnancy. Subsequent pregnancies followingCSP is usually associated with complications such as first or second trimester miscarriage, placenta previa or accretacausing life threatening haemorrhage, emergency hysterectomy and uterine rupture threatening lives of mother andfetus. Given the lack of consensus on treatment modalities of CSP and subsequent pregnancy, babies are usuallydelivered by caesarean section at term. We report on a case describing uncomplicated pregnancy course and successfulvaginal delivery of a woman who had had caesarean scar ectopic pregnancy previously.Case: We report on a case of 38 year old, Gravida 7 P2+4, who was diagnosed with a CSP in her 5th pregnancy and wasmanaged by evacuation of caesarean scar ectopic pregnancy. She presented to us again on her 7th pregnancy in earlypregnancy assessment unit (EPAU) at 7+6 weeks. As she had recurrent miscarriage, Aspirin, Tinzaparin and Cyclogestwere started after dating scan. She also developed gestational diabetes, hence, Metformin and Insulin was initiated. Shewas induced with Dinoprostone at 37+3weeks of pregnancy. Labour was conducted under epidural analgesia and thefetus was continuously monitored throughout labour. Obstetric management was largely based upon current literatureand professional experience as there are not sufficient relevant cases published in literature neither specific guidelinefor the management in subsequent pregnancy after CSP.Results: A Healthy baby of birth weight 3.19kg was delivered without complications with second degree perineal tear.Conclusion: Although, subsequent pregnancy following caesarean scar pregnancy is associated with significantmorbidity at all stages of pregnancy, hence, is recommended to deliver women by caesarean section at term, this casedemonstrates that vaginal delivery is an option with careful case selection, close monitoring and informed consent frompatient