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AJR 2003; 180:284
© American Roentgen Ray Society

Placenta Percreta Versus Ectopic Pregnancy

Deborah Levine

Beth Israel Deaconess Medical Center Boston, MA 02215

I read with interest the case of "Sonography of Placenta Percreta During the First Trimester" [1]. The article nicely illustrates a gestational sac in the scar from a prior cesarean delivery. The case described appears similar to the reports of ectopic pregnancy in a cesarean delivery scar [2,3,4,5,6,7,8]. The distinction between placenta percreta (which necessitates surgery because of invasion of the myometrium and often results in hysterectomy) and ectopic pregnancy in a scar (which may be treated conservatively with methotrexate, depending on the condition of the patient) is important clinically. Was the possibility of ectopic pregnancy considered in this patient?

References

  1. Buetow, MP. Sonography of placenta percreta during the first trimester. (letter) AJR 2002;179:535[Free Full Text]
  2. Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fertil Steril 1997;67:398 -400[Medline]
  3. Valley MT, Pierce JG, Daniel TB, Kaunitz AM. Cesarean scar pregnancy: imaging and treatment with conservative surgery. Obstet Gynecol 1998;91:838 -840[Medline]
  4. Roberts H, Kohlenber C, Lanzarone V, Murray H. Ectopic pregnancy in lower segment uterine scar. Aust N Z J Obstet Gynaecol 1998;38:114 -116[Medline]
  5. Padovan P, Lauri F, Marchetti M. Intrauterine ectopic pregnancy: a case report. Clin Exp Obstet Gynecol 1998;25:79 -80[Medline]
  6. Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Romer T. Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report. Eur J Obstet Gynecol Reprod Biol 2001;99:135 -137[Medline]
  7. Lee CL, Wang CJ, Chao A, Yen CF, Soong YK. Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar. Hum Reprod 1999;14:1234 -1236[Abstract/Free Full Text]
  8. Neiger R, Weldon K, Means N. Intramural pregnancy in a cesarean section scar: a case report. J Reprod Med 1998;43:999 -1001[Medline]

Reply

Michael P. Buetow

Lansing Radiology Associates Sparrow Health System Lansing, MI 48912

I thank Dr. Levine for her letter. In that the gestational sac is abnormally located, the case represents a form of ectopic pregnancy, which was the working diagnosis at patient presentation. Ultimately, the patient's deteriorating clinical condition required surgery, at which it was discovered that the gestational sac had completely penetrated the uterus at the site of the cesarean scar and extended into the anterior cul-de-sac [1].

References

  1. Buetow, MP. Sonography of placenta percreta during the first trimester. (letter) AJR 2002;179:535[Free Full Text]

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