Caesarean scar ectopic pregnancy of 12 weeks: a rare and unexpected long-term complication of caesarean section

Authors

  • Priti Agrawal Department of Obstetrics, Gynecology and Infertility, Aarogya Hospital and Test Tube Center, Raipur, Chhattisgarh, India http://orcid.org/0000-0003-3969-8592
  • Rishi Agrawal Department of General and Laparoscopic Surgery, Aarogya Hospital and Test Tube Center, Raipur, Chhattisgarh, India
  • Sujeet Agrawal Department of Radiology, Shri Shyam Diagnostic Center, Ambikapur, Chhattisgarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20204857

Keywords:

Abortion, Ectopic pregnancy, CS, Transabdominal and transvaginal ultrasound, Hemorrhage

Abstract

Caesarean scar ectopic pregnancy (CSEP) is one of the rarest of all ectopic pregnancies. CSEP is a life-threatening condition and should be timely diagnosed and managed because if left untreated, it may lead to serious complications like uterine rupture, hemorrhage, hypovolemic shock and even maternal death. A 29-year-old female with history of amenorrhea 3 months, was referred from remote rural area with severe abdominal pain and vaginal bleeding for 15 days. Her previous childbirth was by caesarean section (CS), 4 years back. Trans abdominal ultrasonography (USG) revealed gestational sac in lower uterine segment and attached to anterior wall. Upper uterine segment was empty, crown lump length was 5.86 cm corresponding to 12 weeks and 3 days. As the pregnancy was 12 weeks with very thin myometrium covering it and placenta fully covering internal orifice of the cervix uteri (internal OS), took decision for laparotomy. Vaginal bleeding and abdominal pain are the most common presenting symptoms of CSEP. Severe acute abdominal pain or heavy vaginal bleeding may indicate impending rupture while hemodynamic instability may indicate rupture of CSEP. Laparoscopy or laparotomy can be done in such cases to remove pregnancy. Chose laparotomy as it would give quick, better access and control of hemorrhage in this case. The risk of CSEP and placenta accrete should be specially emphasized when counselling women requesting CS for nonmedical reasons. Prompt and accurate diagnosis using transvaginal ultrasonography (TVUS) followed by individualized treatment will significantly help to reduce morbidity related to CSEP.

References

Larsen JV, Soloman MH. Pregnancy in a uterine scar sacculus-an unusual cause of post abortal hemorrhage. S Afr Med J. 1978;53:142-3.

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

Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220-7.

Molinaro TA, Barnhart KT. Ectopic pregnancies in unusual locations. Sem Reprod Med. 2007;25(2):123-30.

Fenerty S, Gupta S, Anoakar J, Patel T. Cesarean scar ectopic pregnancy. Appl Radiol. 2017;46(12):20-21.

Gupta DT, Wahi S. A Rare Case report of cesarean scar ectopic pregnancy. J Clin Diagn Res. 2017;11(8):10-11.

Timor-Tritsch IE, Monteogrido A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment and folloeup of cesarean scar pregnancy. Am J of Obstet Gynecol. 2012;207(1):44.

Jayaram PM, Okunoye GO, Konje J. Cesarean scar ectopic pregnancy: diagnostic challenges and management option. Obstet Gynecol. 2017;19(1):13-20.

Majangara R, Madziyire MG, Verenga C, Manase M. Cesarean Section scar ectopic pregnancy-a management conundrum; a case report. J Medical case rep. 2019;13:137.

Koplay M, Dogan NU, Sivrim M, Erdogan H, Dogan S, Celik C. Ectopic pregnancy in a Cesarean Section scar: successful management using vacuum Aspiration under laproscopic Supervision-mini Review of Current Literature. Case Rep Surg. 2016;2016:4.

Downloads

Published

2020-10-27

Issue

Section

Case Reports