Point-of-care ultrasound (POCUS) for diagnosing cesarean scar ectopic pregnancy in the emergency department

Abstract

Background: Cesarean scar ectopic pregnancy (CSEP) is a rare but potentially life-threatening type of ectopic pregnancy in which implantation occurs within the myometrial defect of a prior cesarean scar. Early recognition is critical due to the risk of severe hemorrhage, uterine rupture, loss of fertility, and maternal death. We report a case of CSEP diagnosed by point-of-care ultrasound (POCUS), highlighting key sonographic findings. Case Presentation: A 37-year-old female presented with lower abdominal pain and amenorrhea. Investigations were positive for pregnancy. POCUS revealed a viable ectopic pregnancy embedded within the myometrium at the cesarean scar, with endogenous growth toward the uterine cavity. These findings were consistent with CSEP, which prompted an emergent obstetric consultation for definitive treatment. Conclusion: This case highlights the potential of POCUS in the emergency setting to expedite CSEP diagnosis and prompt early obstetric consultation, where early recognition may improve clinical outcomes. Therefore, it is important for emergency physicians to recognize the sonographic features of CSEP.