The only condition that can cause this appearance is the possibility of this being an ectopic pregnancy.
1) How does this correlate with the fact that this patient has a history of previous LSCS?
2) Can this pregnancy / sac be somehow related to the LSCS? Are we dealing with a gestation sac in the scar of the previous cesarean section?
The location of the sac in the anterior wall of the uterus is a further clue supporting this possibility. The scar of the LSCS is located in the anterior wall of the lower uterine segment. What is your diagnosis?
Ectopic pregnancy located in LSCS scar – “scar pregnancy” or scar implantation. Scar pregnancy used to be one of the rarest forms of ectopic gestation. However, the rising use of cesarean sections has resulted in an increased incidence of scar pregnancies in the subsequent pregnancies.
1) Aborting gestation sac on its way out of the uterus may present a similar picture. However, an aborting sac would be seen inside the uterine cavity and not inside the myometrial wall. Besides, the embryo in such a sac would be dead and the sac would be oblong with no trophoblastic vascularity around the aborting sac.
2) Cervical pregnancy can also present a similar picture. However the pregnancy would be lower down in the cervix and not within the myometrium.
3) Nabothian cysts can sometimes mimic a scar implantation. However, these are usually thin walled and may be multiple. Nabothian cysts are always located in the cervix.
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