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 Gestational sac implanted in c/s scar 
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Joined: Tue Jul 21, 2009 7:18 am
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Post Gestational sac implanted in c/s scar
Hi everyone. I am desperately searching for info so if anyone can help me out it would be very much appreciated. I recently miscarried at 5/6 weeks with the Dr telling me it was possibly due to low implantation. I fell preggers again straight after the miscarriage and went for my scan today. The sonographer report states the gestational sac has implanted in the caesarean scar. It was recommended I have a termination. I have since seen my GP who said its an incredibly rare condition and he's never personally encountered it. He rang an ob northern suburbs of Perth who said it may be a mistake and to just wait until I have an anatomy scan. I'm extremely nervous about this as I've read some limited literature that suggests it can be fatal to mum and baby. I have a referral to KEMH but I'm not sure when they can get me in - was supposed to be in tonight but apparently since baby is doing fine and I'm not bleeding they've told me to wait and only come in if I bleed. I am terrified I will have a bleed and lose the baby and my uterus and possibly die in the process. But I'm also not wanting to terminate if there's a chance I can carry to term. The GP said I would absolutely have to have a caesarean delivery as best case scenario would be a praevia and accreta. Did I mention I'm terrified? If anyone has ever dealt with this can you please reply!

ETA: I'm only 6 weeks pregnant, have pain in left side but no bleeding and baby had a heartbeat of 110bpm and is positioned near my cervix but whole sac implanted in cesarean scar - I believe it's called an ectopic pregnancy of caesarean scar


Tue Oct 16, 2012 10:58 pm
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Post Re: Gestational sac implanted in c/s scar
Hi mummybugs,

I am sorry to hear you are going through this. I do know of a good friend of mine that is on this forum that this has happened to. I will let her know you are looking for someone to talk to.


Wed Oct 17, 2012 8:16 am
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Post Re: Gestational sac implanted in c/s scar
Heya MummyBugs...
First of all - huge hugs. I am so sorry that you are going through this and have this uncertainty hanging over your head... I'm praying that not only will it all work out for you, but that I can say the right thing to help you right now too.
I had this happen to me this time last year. I was due in May but lost my little girl in December.
In my case, it wasn't noted in the scan notes at the 5 or 9 week scans. I was actually told that the placenta was away from the scar line. I am not sure if they can be accurate at any point where the baby and placenta are so small that they can tell you where it is until like 12 weeks. But once it happened to me, I was able to see alot of signs that this had been going on since implantation.

When I was about 4 or 5 weeks pregnant and my period was due, I had massive back pain (I had felt implant pains and was excitedly waiting to do a test) and then a big (Like a tablespoon) blood gush... then nothing. I was expecting my period to come on and knew that I must be having an early term M/C (I'd never had one before) and was trying to prepare myself for that. But it never came.
All my Home pregnancy tests came back negative. But the pain persisted every now and then and I eventually went to the ER for fear I was having an ectopic pregnancy. Really, it was all a part of the implant happening in my scar line. They could see the sack at 5 weeks, but couldn't see anything inside it and it looked like it was well away from my scar line. But all I can put the bleed down to is that it was trying to implant in my scar line and cause an accreta.

Fast forward to 9 weeks and I go in for a dating and viability scan and I see a perfect HB of 160bpm and a healthy baby on perfect sizes. I ask again if the baby and placenta are away from my scar line and am told that they are and not to worry because it is totally rare that anything would be a problem in that regard.
I start seeing a private midwife for my care and she palps my belly and uses a doppler at each 4 weekly appointment to assess my growth.
I feel no need to go for a 12 week scan because everything was so great at 9 weeks and apart from severe morning sickness in the mornings only, I wasn't having any issues with the pregnancy and would almost "forget" I was pregnant altogether.

Then at right on 20 weeks, a few days before I was due to go for my scan, my MW and another MW couldn't find my baby's HB and also couldn't feel my uterus anymore. My fundus had gone down.
The next day I went in for an U/S that confirmed that I had had a placental abruption and that there was placenta all over my scar line. My baby had stopped growing, even though my placenta was probably normal size. I felt no pain and had no idea when it actually all happened. But I had my MW, Doula, husband and mum there in that time to surround me and help me come to terms with it all...
Lilly-Anne was my much wanted VBAC too...

I came home and I did a little research about it because even though I was given the all clear by an Ob to start trying again in 6 months (I had to have a D&C to make sure all the placenta was scrubbed away because it probably couldn't have come out by itself) and to even go for a VBAC because whilist the placenta was on the scar line, it didn't actually penetrate it.
What I found was that if a baby truly is IN the scar line (As in it's placenta is), it is termed a placenta Previa. Anyone can have a low-lying placenta early in pregnancy, but they move, and they are programmed to move up. Either up the front wall or the back wall of the uterus. When it goes up the front wall and is an anterior placenta, there is the risk that it will encounter the tough and exposed scar tissue of your C/S scar line. When that happens it often can't move any further. (Think sea slug that moves across the ground of the ocean and relies on being able to move it's little sucker thingos to help it move from one place to the other, the placenta is pretty much the same and moves it's connections as it goes). When the placenta actually stays in that place it is placenta previa usually (Because it will have usually started from below the scar line and tried to move up and so stays low when it gets stuck), but what is of more of a concern is either placental abruption (Instantly fatal to the baby and when the placenta becomes un-stuck) or placenta accreta (Where the placenta actually seperates the scar line and grows through the uterus). This is what you would have found when you read that this situation can be fatal to mum and baby. Not because it is instantly fatal, but because managing it, getting you to full term and delivering the baby is so risky.

As I said, in my case they have photos and stuff from inside my uterus that assured me that it wasn't placenta accreta. But I have found this thread on another forum (That I can't find right now, but I will keep looking) where the mum was also recommended that she should terminate. It was something she wouldn't consider and so instead consented to constant U/S to monitor baby's growth and also the effect on her uterus. The placenta did eventually penetrate her uterus, but the baby and her kept going well. She had an Ob that explained all the risks to her and supported her choice to continue the pregnancy. She had 3 children already and so knew that having a hysterectomy (Which it became obvious in her pregnancy, once she had the accreta, would become a necessity) wasn't too much to do in order to save her and the baby.

But that was a choice she made with her own situation in mind. No 2 implants on a scar line will be the same. No 2 scars will react the same way.
A termination brings it's own risks and as you've said, you want to be sure that there is no chance you can carry to term or do so safely, before you make any decisions.
It is a difficult path to tread, and you want to make sure you do it with caregivers who have actually seen this before. King Edwards, being the tertiary hospital, is a great place to start. They have the best high-risk obstetricians in the state working there. They see it all. They see lots of placental abruptions, accreta and previa. They know what they are looking for.
I would present there if you can't get an appointment and "self refer" to get in. Get more scans done. Ask the right questions to make sure that who you are speaking to knows exactlly when this information can actually show up accuratly in a scan.
Unfortunantly, if you had your scan at a regular "Perth radiology" type place, those people aren't even highly experienced in Obstetric scans. They ultrasound all sorts of body parts everyday and as I have found with them, 2 of their radiographers DIDN'T pick up my placenta's location (Whether that was because it was not possible at that point in time or because they were incompitent, who knows). But the sonographers at KEMH and the private radiology places that surround it (Like Subiaco women's imaging) are VERY experienced and can tell you what they expect to see and when.

I pray that you feel like I've been able to give you some information. Unfortunatly with something like this, it isn't something you can read in "What to expect when you're expecting" and take it as gospel. There is no hard and fast rule about how these things work out.
But take heart! Worry doesn't change the situation one bit (OMG... the things I worried about in that pregnancy, and this one! They didn't even verge on this and none of those things happened and this did!). But trust that when you have more information, then you can make a decision. Don't feel that you need to have all your decisions and reactions to this mapped out right now. Because alot of the time, as with anything in pregnancy, it isn't a land you can map.

Much love to you and please keep us updated as to how you go... <3 I will be praying for you and your baby...

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Wed Oct 17, 2012 10:32 am
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Post Re: Gestational sac implanted in c/s scar
Thank you so much for the reply. I've had the run around big time today but have since been contacted by midwife at KEMH who has told me not to eat or drink anything and come in straight away. I will ask for a scan to double check as the woman who did it yesterday was pretty rude and quick. I want to make sure this isn't a mistake. Complicated very much by the fact I've got lower back pain and am now frightened out of my wits.


Wed Oct 17, 2012 11:46 am
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Post Re: Gestational sac implanted in c/s scar
Praying MummaBugs!!! Keep us updated <3

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Wed Oct 17, 2012 5:25 pm
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Post Re: Gestational sac implanted in c/s scar
Have spent whole afternoon at KEMH where the staff were all lovely! I had the head sonigrapher and consultant do a second internal ultrasound. They took quite a while and the verdict is NO ectopic or scar implantation. They said my scar looks perfect and the gestational sac is under the scar. It's an abnormal implantation as it is very low lying but they saw heartbeat and baby measured 6 weeks 1 day with HCG of 16000. I had to be prodded and poked and the internal exam hurt like buggery plus they used q tips to clear away mucous to check my cervix. Was given all clear and told to go back in 2 weeks for another scan. Unfortunately I've gotten home and started bleeding :-( I'm so hoping it may just be from the internal exam as I have no stomach cramps! Thank you Pioneer Mama for your support


Wed Oct 17, 2012 7:30 pm
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Post Re: Gestational sac implanted in c/s scar
Oh hun! I am glad they are nice! Sorry that you had to go through all the crap. I've had 2 internal U/S done and they always left me feeling crampy.
Just keep trusting your instincts though and if you feel like you need to go back for any reason, do.
Hope the bleeding settles down. Keep us updated!!! <3

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Thu Oct 18, 2012 6:10 pm
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Post Re: Gestational sac implanted in c/s scar
Ladies, I am feeling so blessed to have come across this forum. I was recently diagnosed with a variation of CSP at about 6 weeks; however, neither of the two doctors nor the radiologist who looked at my scans have ever seen this before in person. They tell me it is not a classical case because the pregnancy is not embedded in the scar but it is adjacent to it, and the radiologist who specializes in ultrasounds said he thought there was trophoblastic tissue extending into the scar. I am being told there is a 95% chance this is a CSP and that I would most certainly end up with a placenta accreta (and possible hysterectomy) or worse and that we should consider termination. But the risks associated with termination aren't great either (20-40% chance of major hemorrhage, possible blood transfusion and at the worst a hysterectomy). We have one healthy child who is 6 months old. I did have some bleeding only on two occasions, which they attribute to a subchorionic hematoma I have further complicating this situation, but they think there's a chance it will resolve. I too thought I was having a miscarriage the first time I saw it and called my dr right away. He had me come in the next day for a follow up u/s and everything was still intact. My HCG levels continued to rise, which was a surprise to him because he kept telling us it did not look like it was developing normally. It implanted low and was a funny shape (oblong), which we now think is because it trails into the scar. My husband and I are both very afraid and feel like we are being asked to make an impossible decision. And time is of the essence since there is a possibility if uterine rupture with this condition. We need to have a decision made in the next week or so. On the one hand we could have faith and move forward hoping that because this is not a classical case maybe we have a chance we could end up with a baby at the end if this, but we could end up being sent to a medical center hours away to be monitored by specialists as early as 24 weeks. We both work full time and have our baby to care for so this is not really feasible if this were to happen. Plus if the baby had to be delivered that early the rate of survival is not good or could lead to a complicated life for it. If we choose to terminate we would again have to be referred because the Catholic hospital we attend does not perform those so we would have to be in a strange place with doctors we didn't know. Our hearts are breaking and I'd like to know how each of your situations turned out. I've read there is not a strong chance of this recurring but the rate of successful full term babies after treatment of CSP was not great either. Thanks for listening and I would sincerely appreciate your guidance.


Sat May 17, 2014 5:56 pm
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