When IVF Implants in a Cesarean Scar: Early Diagnosis Preventing a Catastrophic Outcome

Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic implantation, with an estimated incidence of 1 in 1,800–2,500 cesarean deliveries. Its occurrence is increasing in parallel with rising cesarean section rates and the expanding use of assisted reproductive technologies, including in vitro fertilization (IVF). CSP carries a high risk of severe hemorrhage, uterine rupture, and loss of fertility if diagnosis is delayed. We report a case of IVF-associated CSP diagnosed early and managed conservatively, highlighting key clinical decision-making and preventive strategies.

A 34-year-old woman (G4P1) with one previous lower-segment cesarean section conceived through IVF and presented at 5+2 weeks’ gestation with vaginal bleeding and passage of clots. Clinical findings, laboratory investigations, and high-resolution transvaginal ultrasound with color Doppler were reviewed. Management decisions were undertaken through a multidisciplinary obstetrics team with close clinical monitoring.

Transvaginal ultrasound demonstrated a gestational sac with yolk sac implanted within the previous cesarean scar, with surrounding vascularity on Doppler imaging, confirming cesarean scar pregnancy. The patient remained hemodynamically stable with preserved hemoglobin levels. Due to ongoing bleeding, ultrasound-guided suction evacuation (ERPOC) was performed under anesthesia. Complete removal of products of conception was achieved with real-time ultrasound confirmation of an empty uterine cavity. Estimated blood loss was 150 mL, with no intraoperative or postoperative complications. The patient recovered uneventfully and was discharged the following day with follow-up and counseling.

Cesarean scar pregnancy is an increasingly recognized complication in IVF conceptions and poses a significant risk of maternal morbidity if not identified early. Prompt diagnosis using transvaginal ultrasound enables timely, conservative intervention and avoidance of catastrophic outcomes. In carefully selected, hemodynamically stable patients, ultrasound-guided surgical evacuation is an effective uterus-preserving management option. This case emphasizes the importance of early imaging, heightened clinical suspicion, and individualized multidisciplinary care.