Embryo implantation in a cesarean scar is a rare event and a risk factor for placenta previa or accreta.1 Despite an increasing number of reports of scar pregnancy in the obstetric literature,2'3 limited anesthetic guidance is available. A previously healthy 31-year-old woman (G5P4) presented for dilation and curettage (D&C) at 16 weeks of gestation, five weeks after embryonic demise. Her obstetric history included one cesarean and three vaginal deliveries. Ultrasound examinations at 8 and 9 weeks showed a lower uterine segment gesta-tional sac consistent with a scar pregnancy, which was reconfirmed at 11 weeks, when embryonic demise was also diagnosed. She elected to have observant management and was seen at 16 weeks following a week of light vaginal bleeding. Ultrasound examination showed a persistent gestational sac without fetal cardiac activity and an ultrasound-guided D&C was advised. Information -regarding the scar pregnancy was not disclosed to the anesthesia team.
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