Critical Diagnosis and Management of a Case of a Partial Molar Cesarean Scar Ectopic Pregnancy

TL;DR

This case report details the diagnosis and management of a rare pregnancy complication involving a partial molar pregnancy in a cesarean scar.

Contribution

The paper presents a rare case combining a partial molar pregnancy with a cesarean scar ectopic pregnancy and discusses its management.

Findings

A 43-year-old patient with a cesarean scar ectopic pregnancy and partial molar pregnancy underwent a gravid hysterectomy.

Pathology confirmed a partial molar pregnancy in the cesarean scar without accreta.

Early imaging review is critical for diagnosing this rare condition.

Abstract

The objective of this case report is to highlight critical findings of a cesarean scar partial molar ectopic pregnancy and review the counseling and management strategies. A 43-year-old G3P0201 patient with a history of two cesarean deliveries at 10 weeks 3 days by last menstrual period presented to the ED with a week of dark brown discharge. The patient had previously been diagnosed with a pregnancy of uncertain viability five weeks prior at an outside institution but was lost to follow-up. Transvaginal ultrasound and pelvic computed tomography were performed to guide counseling and recommendations for the management of what was concerning for both a partial molar pregnancy and a cesarean scar ectopic pregnancy (CSEP). After counseling, the patient underwent a gravid total abdominal hysterectomy and bilateral salpingectomy for definitive management of the CSEP, as she had satisfied her fertility goals. Pathology of the specimen confirmed a partial molar pregnancy in the cesarean scar without evidence of an accreta. Close review of early pregnancy imaging is critical in making a diagnosis of a caesarean scar ectopic pregnancy complicated by a molar pregnancy. A gravid hysterectomy may reduce the morbidity of this combination of rare pregnancy pathologies.

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