A rare case of ruptured caesarean scar pregnancy

Authors

  • Pooja Bhatia Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India https://orcid.org/0000-0001-8506-8001
  • Radhika Gupta Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
  • Manjeet Kaur Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
  • Dilpreet K. Pandher Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
  • Rimpy Tandon Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
  • Poonam Goel Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230833

Keywords:

Caesarean scar pregnancy, Ectopic pregnancy, Misoprostol, Scar rupture

Abstract

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. The incidence is approximately 1:2000 pregnancies and has potentially life-threatening complications. Ours is a rare case of scar ectopic pregnancy who had taken medical termination of pregnancy (MTP) kit while being unaware of her pregnancy location and presented with uterine rupture and hemoperitoneum. A 24-year-old female, P2L2A1, with previous two caesarean section (CS), presented with the complaint of bleeding per vaginum with acute pain abdomen and history of MTP kit intake at 7 weeks’ period of gestation (POG). She received symptomatic treatment at local hospital without any diagnosis being made but brought an ultrasound showing anterior myometrium defect with scar site hematoma and free fluid. She presented with moderate pallor, tachycardia and suprapubic tenderness. She was subsequently taken up for laparotomy in view of probable ruptured CSP. Intra-operatively, actively bleeding scar ectopic was seen with hemoperitoneum. The contents were scooped out and repair done with bilateral tubal ligation. She was resuscitated with adequate blood products. Embryo implantation in the region of a previous CS scar is rare and a delay in either diagnosis or treatment can have catastrophic complications like haemorrhage, rupture and significant maternal morbidity as seen in our case. Therefore, we should have a high index of suspicion of scar pregnancy especially in cases of previous CS so that timely intervention can be done preventing maternal morbidity. Unwarranted use of misoprostol can be deleterious when site of implantation is unknown, particularly in CSP.

References

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

Fylstra DL, Pound-Chang T, Miller MG, Cooper A, Miller KM. Ectopic pregnancy within a cesarean delivery scar: a case report. Am J Obstet Gynecol. 2002;187(2):302-4.

Lin EP, Bhatt S, Dogra VS. Diagnostic clues to ectopic pregnancy. Radiographics. 2008;28:1661-71.

Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16(6):592-3.

Jayaram PM, Okunoye GO, Konje J. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. Obstet Gynaecol. 2017;19:13-20.

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.

Sentilhes L, Vayssière C, Beucher G, Deneux-Tharaux C, Deruelle P, Diemunsch P. Delivery for women with a previous cesarean: Guidelines for clinical practice from the French college of gynecologists and obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2013;170:25-32.

Stevens EE, Ogburn P. Cesarean scar ectopic pregnancy: a case report of failed combination local and systemic methotrexate management requiring surgical intervention. J Reprod Med. 2011;56(7-8):356-8.

Downloads

Published

2023-03-28

Issue

Section

Case Reports