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2026 SOAP Annual Meeting
April 29 - May 3, 2026 | Montreal, Quebec Canada
2339402
A Preventable Delay: Cesarean Scar Ectopic Pregnancy Complicated by Restrictive Reproductive Policy
Poster Presenter
Authors
Affiliations
Part of Topic
ETHICS
A Preventable Delay: Cesarean Scar Ectopic Pregnancy Complicated by Restrictive Reproductive Policy
Jil Decker, MD, Elise Boos, MD, Edward Yaghmour, MD, Laura Sorabella, MD
Society for Obstetric Anesthesia and Perinatology Annual Meeting
5/2/2026
Background
•Tennessee maintains some of the most restrictive reproductive laws in the United States
•With Dobbs v. Jackson, the termination of a pregnancy became criminal in the state of TN with no exceptions for ectopic or molar pregnancies
•In 2023, exceptions to abortion ban were passed and ectopic and molar pregnancies were legally defined as distinct from abortion care [1]
•Unclear guidelines create litigation concerns for physicians and result in delays in necessary obstetric intervention
The Case
•27-year-old G5P1302 with history of CDx2 including one neonatal demise at 12w1d
•8:30 PM: Presented to ED with acute onset lower abdominal pain and vaginal bleeding
•12:30 AM: Ultrasound and bHCG levels consistent with early pregnancy loss in progress, with concern for dehiscence and hemorrhage at prior cesarean scar. OB/GYN consulted, patient clinically stable
•8 AM: Patient taken to the OR as a STAT case. Diagnostic laparoscopy consistent with a cesarean scar ectopic pregnancy without frank uterine rupture
•Intraoperative: The team performed a laparoscopic supracervical hysterectomy. Post-operative surgical pathology confirmed placenta accreta spectrum grade 3a involving the cesarean scar.
•Postoperative: The patient remained hemodynamically stable and did not require transfusion. She was discharged on post-operative day 1
Teaching Points
•Delays between recognition of pathology and surgical intervention lead to significant morbidity and mortality
•Restrictions on abortion care and ambiguous “medical emergency” standards contribute to delays and denial of care to pregnant patients, even those with high-risk pregnancy complications
•Healthcare laws that allow physicians to offer all appropriate interventions are essential to improve outcomes for pregnant patients