PMC6215580_01
Sonographic imaged before selective reduction of cesarean scar pregnancy with potassium chloride (KCl injection). Upper left demonstrates cesarean scar pregnancy (AA) and intrauterine pregnancy (BB). Upper right demonstrates that cesarean scar pregnancy in close proximity to serosal edge of the uterus. Lower right and left demonstrate live pregnancy of Twin A (cesarean scar pregnancy) and Twin B (intrauterine pregnancy).
CRIOG2018-6478589.001.jpg
PMC6215580_01_CRIOG2018-6478589.001.jpg
fig1
Sonographic findings when patient presented to the emergency room initially with the heterotopic gestation with a C-section scar ectopic containing fetal parts without discernible heart rate and an abnormal appearing intrauterine gestational sac in the lower uterine segment containing only low-level echoes.
CRIOG2018-6478589.002.jpg
PMC6215580_01_CRIOG2018-6478589.002.jpg
fig2
Ultrasound confirmed presence of no fetal cardiac activities and presence of high vascular flow to the myometrium surrounding the cesarean scar pregnancy (Figure 2).
CT A/P with IV contrast with sagittal view demonstrating distention of the lower uterine segment of endometrial cavity.
CRIOG2018-6478589.003.jpg
PMC6215580_01_CRIOG2018-6478589.003.jpg
fig3
CT scan of the abdomen and pelvis demonstrated a large high-density material within the endometrial cavity of lower uterine segment (Figure 3).
Bivalved uterus specimen shows anterior placenta adherent to lower uterine segment.
CRIOG2018-6478589.004.jpg
PMC6215580_01_CRIOG2018-6478589.004.jpg
fig4
The specimen was bivalved to show the entire uterine cavity with large amounts of blood clots, adherent placental tissue as well as a very thin anterior uterine segment (Figure 4).