An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar. A case report.

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We report a case of cervical intramural pregnancy at the lower incision line of a previous cesarean section. A 21 year-old multigravida consulted our hospital because of amenorrhea and genital bleeding. Transvaginal ultrasonic imaging revealed that the gestational sac existed in a position away from the endometrium, and a fetus-like shadow was observed in the myometrium. In the operation, we recognized a hen's egg-sized mass at the anterior wall of the uterine body. Although excision of the lesion was attempted in order to preserve the uterus, hemostasis became difficult and hysterectomy was performed. Histologically, the part in which the tunica muscularis was perpendicularly thin from the cervix of the uterus to the conversion division (near the histological internal os of the uterus)existed. The gestational sac was recognized to be located within the tunica muscularis. Pregnancy developing in a previous cesarean section scar is the rarest kind of all ectopic pregnancies. It seems to be important to accurately comfirm the implantation position in the diagnosis in the early stage of pregnancy. [Adv Obstet Gynecol 52 (1); 14 18, 2000 (H.12.1)]
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