Accidental diagnosis and conservative management of a case of first-trimester caesarean scar ectopic pregnancy

Authors

  • Ahmed M. Abbas Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Shymaa S. Ali Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Mohammed Nagy Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt
  • Fady Nasif Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Egypt

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20181368

Keywords:

Cesarean section, Ectopic pregnancy, First-trimester, Maternal morbidity

Abstract

Cases of Caesarean Scar Ectopic Pregnancy (CSEP) are becoming increasingly common at tertiary care hospitals because of increase in rate of CS. It may lead to horrible consequences, such as uncontrolled bleeding and uterine rupture (UR), which might require hysterectomy and result in subsequent loss of fertility. This report covers a case of a CSEP discovered early at 9 weeks of gestation in a 25-year-old woman coming for antenatal care. Conservative management of the uterus was performed with removal of the sac and repair of the uterine scar. The patient’s postoperative period was uneventful, and she was discharged 3 days after surgery. CSEP should be detected early to prevent its catastrophic sequences. Although it is a rare complication of cesarean section, CSEP must be kept in the minds of obstetricians facing emergency cases.

References

Chang J, Elam-Evans LD, Berg CJ, Herndon J, Flowers L, Seed KA, et al., Pregnancy related mortality surveillance-United States, 1991–1999. MMWR Surveill Summ. 2003;52:1-9.

Herman A, Weinraub Z, Avrech O, Maymon R, Ron‐El R, Bukovsky Y. Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar. BJOG: Int J Obstet Gynaecol. 1995;102(10):839-41.

Ghezzi F, Lagana D, Franchi M, Fugazzola C, Bolis P. Conservative treatment by chemotherapy and uterine arteries embolization of a Caesarian scar pregnancy. Eur J Obstet Gynecol Reprod Biol. 2002;103:88-91.

Maymon R, Halperin R, Mendlovic S, Schneider O, Herman A. Ectopic pregnancies in a Cesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod. 2004;19:278-84.

Peng KW, Lei Z, Xiao TH, Jia FG, Zhong WX, Gao Y et al., First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol. 2014;69:123-9.

Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23:247-53.

Cheng PJ, Chueh HY, Soong YK. Sonographic diagnosis of a uterine defect in a pregnancy at 6 weeks gestation with a history of curettage. Ultrasound Obstet Gynecol. 2003;21(5):501-3.

Hamilton CJ, Legarth J, Jaroudi KA. Intramural pregnancy after in vitro fertilization and embryo transfer. Fertil Steril. 1992;57:215-7.

Abbas AM, Ali SS, Michael A, Badran SA. Caesarean Scar Ectopic Pregnancy Complicated by Uterine Rupture at 10 Weeks Gestation. J Gynecol Surg. 2017;33(6):261-3.

Yu XL, Zhang N, Zuo WL. Cesarean scar pregnancy: an analysis of 100 cases. Z Honghua Med J. 2011;91(45):3186-9.

Ben Nagi J, Helmy S, Ofili-Yebovi D, Yazbek J, Sawyer E, Jurkovic D. Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies. Hum Reprod. 2007, 22: 2012-5.

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG: Int J Obstet Gynaecol. 2007;114(3):253-63.

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies etiology, diagnosis and management. Obstet Gynecol. 2006;107(6):1373-81.

Downloads

Published

2018-03-27

Issue

Section

Case Reports