Molar Cesarean Scar Pregnancy, Rare Ectopic Pregnancy, Dr Priyanka Thakur Sharma, Rajasthan Hospital Jaipur-

Jaipur, Sep.24,2025:Saving life and saving uterus became a reality at Rajasthan Hospital, Jaipur, where Dr. Priyanka Thakur Sharma, Consultant Gynaecologist, successfully diagnosed and managed an extremely rare molar caesarean scar pregnancy (molar CSP). This case is notable as only the 10th ever reported worldwide, making it a landmark in obstetric care-

According to Dr. Priyanka, caesarean scar pregnancy itself is rare, and its combination with molar pregnancy is exceptionally uncommon, with only nine documented cases in medical literature. Early diagnosis and timely intervention in this case saved both the patient’s life and her uterus.

Understanding Caesarean Scar Pregnancy

A caesarean scar pregnancy (CSP) occurs when a fertilized egg implants on the scar tissue from a previous C-section rather than in the uterine lining. This rare type of ectopic pregnancy can lead to severe bleeding, uterine rupture, and maternal complications if not managed promptly.

According to MedlinePlus, CSP requires immediate identification and expert care to prevent life-threatening outcomes.

Molar Pregnancy and Its Risks

A molar pregnancy is an abnormal form of pregnancy in which abnormal trophoblastic tissue grows inside the uterus. It may be partial or complete and can occasionally progress to gestational trophoblastic neoplasia (GTN) if untreated.

When combined with caesarean scar implantation, the risk of uncontrolled haemorrhage and uterine rupture increases drastically, making early intervention critical. Most cases of molar CSP often result in hysterectomy to control bleeding.

Patient Case-Initial Symptoms and Evaluation

The patient, a 34-year-old woman with two previous C-sections, presented with continuous vaginal bleeding for one month and increasing abdominal pain for 10 days. She had a history of miscarriage two months earlier and another miscarriage six months prior.

On admission, she showed signs of shock: low blood pressure, high pulse, and haemoglobin of 7 gm/dl. Initial ultrasound suggested a ruptured caesarean scar ectopic pregnancy with a possibility of molar tissue, later confirmed by CT angiography.

Given the risk of massive haemorrhage, the multidisciplinary team acted swiftly to stabilize her condition.

Urgent Intervention- Bilateral Uterine Artery Embolization

To control potential excessive bleeding, the Interventional Radiology (IR) team performed bilateral uterine artery embolization (UAE) before surgery. The patient also received 2 units of blood preoperatively.

This preemptive step significantly reduced intraoperative bleeding, enabling the surgical team to proceed with uterus-preserving surgery instead of hysterectomy.

Surgical Management and Uterus Preservation

During surgery, 2 Liters of blood were found in the abdominal cavity, along with rupture at the previous C-section scar and abnormal molar tissue.

Dr. Priyanka Thakur Sharma’s team completely excised the ectopic tissue and carefully closed the uterus in layers. Both the patient’s life and uterus were preserved, marking an exceptional outcome in such a high-risk scenario.

Postoperative reports showed serum β-hCG levels dropped from 55,000 preoperatively to 188, confirming successful removal of the molar tissue. Biopsy revealed partial hydatidiform mole, ensuring accurate diagnosis and follow-up.

Postoperative Recovery and Follow-Up

The patient recovered rapidly and without complications, highlighting the importance of timely diagnosis and multidisciplinary care.

Follow-up monitoring of β-hCG levels and imaging remains critical to ensure no recurrence or progression to GTN. Early detection and intervention help prevent uterine rupture, excessive bleeding, hysterectomy, and maternal morbidity.

Clinical Importance and Awareness

Molar CSP is extremely rare, with only nine previous global cases reported. Dr. Priyanka emphasizes that awareness among gynaecologists, obstetricians, and radiologists is vital for:

• Timely diagnosis
• Prompt intervention
• Uterus preservation
• Reducing maternal complications and mortality

This case demonstrates how modern medical techniques and expert care can save lives while preserving reproductive potential. For more information, visit American Pregnancy Association.

Lessons for Obstetric Care

This rare 10th case of molar caesarean scar pregnancy underscores the critical importance of-

• Early diagnosis using ultrasound and CT angiography
• Interventional radiology for haemorrhage control
• Meticulous surgical removal with uterus preservation
• Postoperative monitoring of β-hCG levels

Dr. Priyanka Thakur Sharma’s timely management at Rajasthan Hospital successfully saved the patient’s life and her uterus, providing an important learning model for obstetric emergencies worldwide.