DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20205270

The marks that humans’ leave are too often scars

Nandita Sushilkumar Kaushal, Shrikrushna Vasant Chavan, Arundhati Gundu Tilve, C. V. Hegde

Abstract


Caesarean scar ectopics are the newest member of this obstetric emergency. Although rare, are associated with torrential haemorrhage. Gravida 3 para 2 with previous two caesarean sections with spotting per vaginum. Ultrasound showed a pregnancy embedded in the scar of previous caesarean section. MRI confirmed it. Beta human chorionic gonadotropin (HCG) was 15000 which dropped to 5000 after. An innovative approach was taken to laparoscopically evacuate the pregnancy. The products of conception were removed and the incision sutured so as to achieve haemostasis. Beta HCG was 15000 which dropped to 5000. Patient was haemodynamically stable and discharged on day 3. An innovative approach with skilled surgical technique not only decreased the morbidity but also avoided an unnecessary hysterectomy.


Keywords


Previous-caesarean, Scar-ectopic, Laparoscopy, B-human chorionic gonadotropin, Ultrasound

Full Text:

PDF

References


Le A, Shan L, Xiao T, Zhuo R, Xiong H, Wang Z. Transvaginal surgical treatment of cesarean scar ectopic pregnancy. Arch Gynecol Obstet. 2013;287: 791-6.

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

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etio¬logy, diagnosis, and management. Obstet Gynecol. 2006;107:1373-81.

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 in Obstetrics and Gynecology. J Int Soc Ultras Obstet Gynecol. 2003;21(3):220-7.

Moschos E, Sreenarasimhaiah S, Twickler DM. First‐trimester diagnosis of cesarean scar ectopic pregnancy. J Clin Ultrasound. 2008;36:504-11.

Wlaźlak E, Surkont G, Shek KL, Dietz HP. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data? Eur J Obstet Gynecol Reprod Biol. 2015;193:114-7.

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

Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:44.e1-13.

El Guindi W, Alalfy M, Abasy A, Ellithy A, Nabil A, Abdalfatah O et al. A report of four cases of caesarean scar pregnancy in a period of 24 months. J Med Diagn Meth. 2013;2:2.

Chiang AJ, La V, Chou CP, Wang PH, Yu KJ. Ectopic pregnancy in a cesarean section scar. Fertil Steril. 2011;95:2388-9.

Petersen KB, Hoffmann E, Larsen CR, Nielsen HS. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105(4):958-67.