Objective: To determine clinical outcome for patient with scar ectopic pregnancy after definitive treatment at University Malaya Medical Centre.

Case Report: Madam II, 36-year old lady, G5P3+1, with period of amenorrhoea six weeks, was referred for suspicious cervical ectopic pregnancy on 16/3/2017.  The urine pregnancy test was positive. She was well without any symptoms. She had history of previous myomectomy, followed by three Caesarean deliveries in 2007, 2009 and 2013, after which tubal ligation was not performed. Her general physical examination was unremarkable with stable vital signs. During ultrasound examination, there was a viable fetus in the gestation sac of 16 x 17 x 21 mm situated in anterior lower part of uterus just superior to the internal cervical os. This sac was implanted at the site of her Caesarean scar. The couple was counseled for conservative management with Methotrexate injection vs surgical management with resection of scar ectopic with uterine preservation or hysterectomy. They were informed that scar ectopic typically does not respond well to conservative management with embryocide followed by Methothrexate as high risk of subsequent potentially catastrophic hemorrhage. The couple opted for hysterectomy. She underwent abdominal hysterectomy with conservation of both ovaries on 17/3/2017.  Intraoperatively, moderate peritoneal serous fluid with sigmoid colon adherent to posterior wall of uterus due to previous myomectomy was seen. The unruptured pregnancy was noted at the lower segment scar site of the uterus. Histopathology of specimen reported as placenta accreta consistent with scar pregnancy. The sections of the lower uterine segment showed chorionic villi, with syncytiotrophoblast and cytotrophoblast directly abutting myometrial smooth muscle. Intact surface endometrium shows secretory glands and decidual stroma. She made her smooth recovery from surgery and discharged on 19/3/2017.

Conclusion: Because of the global rising trend of Caesarean deliveries, scar ectopic pregnancy is no longer rare condition nowadays. The careful ultrasound examination of the uterus in the early pregnancy would help to detect scar ectopic pregnancy if the gestational sac is not suited at the fundus and visible at the lower part of the uterus. The rupture of scar ectopic can be castastrophic as intraperitoneal bleeding can be torrential and difficult to secure if coexisting with adhesion due to previous Caesarean surgeries, and also have to anticipate injury to bladder. By early detection, lengthy counseling to the couple, and adopting the best treatment option for individual patient with scar ectopic pregnancy can save the woman’s life.