UNVEILING THE HIDDEN; IMAGING FEATURES AND MANAGEMENT OF CAESAREAN SCAR ECTOPIC PREGNANCY, INSIGHT FROM A CLINICAL STUDY OF 10 YEARS’ EXPERIENCE IN TERTIARY CARE HOSPITAL

Authors

  • Ranam Akhtar Diagnostic radiology, Shifa International Hospital
  • Suraya Bano Shifa International hospital.
  • Zenab Farooq Shifa International hospital.
  • Shazia Fakhar Shifa International hospital.
  • Amna Mehboob Shifa International hospital.
  • Ahmad Talha Tariq Shifa International hospital.
  • Rana Amer Shifa International hospital.

Keywords:

ectopic pregnancy, Transvaginal sonography, gestational sac, uterine artery embolization, methotrexate

Abstract

Background: Cesarean‑scar ectopic pregnancy (CSEP) is the rarest form of ectopic gestation but its incidence is climbing with global cesarean delivery rates. Our study aims to describe the imaging characteristics and management outcomes in a cohort of 35 patients diagnosed with CSEP. Methods: Retrospective review of all CSEP diagnosed between January 2014 and October 2024. Imaging modalities, therapeutic approach, success rates and complications were analyzed using radiology information system. Results: Mean age of the participants was 36±5.07 years. Mean gestational age at the time of diagnosis was 7.4±2.63 weeks. Transvaginal sonography (TVS) was performed and all the cases had empty endometrial canal with low lying and anteriorly displaced gestational sac (100%). Majority of the cases, i.e., 24 (68.6%) showed thinned out residual myometrium (less than 2.5mm). It was seen that the sac which is distorting the external uterine contour (Grade III and IV) was significantly associated with invasive surgical management (hysterectomy) with a p value of 0.015 and when treated with non-surgical options (local /systemic methotrexate) or minimally invasive options (suction and curettage), it was significantly associated with complications like bleeding requiring uterine artery embolization (p-value 0.003). Transvaginal sonography guided local methotrexate and KCL injection had 100% success rate in our study group without complications. Conclusion: This study highlights the key imaging features of CSEP and the varied management approaches tailored to individual patient profiles. Our study confirms that the contour deforming type of sac is significantly associated with invasive surgical management.

Author Biographies

Suraya Bano , Shifa International hospital.

Consultant Diagnostic Radiology  

Zenab Farooq , Shifa International hospital.

Resident Diagnostic Radiology 

Shazia Fakhar , Shifa International hospital.

Consultant Obstetrics and gynecology

Amna Mehboob, Shifa International hospital.

Resident Diagnostic Radiology 

Ahmad Talha Tariq, Shifa International hospital.

Resident, Internal Medlicine

 

Rana Amer, Shifa International hospital.

Senior sonologist, Shifa International hospital. 

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Published

2026-05-21

How to Cite

1.
Akhtar R, Bano S, Farooq Z, Fakhar S, Mehboob A, Tariq AT, et al. UNVEILING THE HIDDEN; IMAGING FEATURES AND MANAGEMENT OF CAESAREAN SCAR ECTOPIC PREGNANCY, INSIGHT FROM A CLINICAL STUDY OF 10 YEARS’ EXPERIENCE IN TERTIARY CARE HOSPITAL. J Ayub Med Coll Abbottabad [Internet]. 2026 May 21 [cited 2026 May 21];37(4). Available from: https://www.jamc.ayubmed.edu.pk/index.php/jamc/article/view/14435

Issue

Vol. 37 No. 4 (2025): 37-4

Section

ORIGINAL ARTICLE

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Copyright (c) 2026 Ranam Akhtar, Suraya Bano , Zenab Farooq , Shazia Fakhar , Amna Mehboob, Ahmad Talha Tariq, Rana Amer

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