Document Type : Case Report
Authors
1 Obstetrics & gynecology department, Shiraz University of medical science, Shiraz, Iran
2 Fetal-maternal research center, Pathology department, Shiraz University of medical science, Shiraz, Iran
3 Infertility research center, Obstetrics & gynecology department, Shiraz University of medical science, Shiraz, Iran
Abstract
Introduction: Pregnancy in caesarean scar site is a rare event. Considering the increasing number of recent caesareans and, as a result, the increasing prevalence of this type of pregnancy, early diagnosis can prevent harmful consequences. Doppler ultrasound is the best method for the early diagnosis of this type of pregnancy. MRI is used in cases where sonography cannot be of any help. An ideal treatment modality for this type of pregnancy has not been devised yet.
Case report: Herein we describe a case of caesarean scar ectopic pregnancy that in spite of having a steady decrease in BhCG titer after treatmentshe came with unstable hemodynamic state and emergency laparotomy and hysterectomy was done for her. She is a 32 y/o lady with the history of two previous cesarean sections who had missed menstrual period and spotting. The patient had stable vital signs upon arrival. No abnormalities were observed while being examined. A lesion with massive blood flow was seen in transvaginal sonography. MRI was done to confirm the diagnosis and a heterogeneous structure with prominent abnormal vasculature was seen in the lower segment of the anterior part of the uterus. The patient was given methotrexate and leucovorin for 8 days. BhCG titer was normal and, having had stable condition, the patient was discharged 8 days later. Four days later, the patient referred with massive vaginal bleeding and she went under emergency laparotomy and, considering her situation, hysterectomy was performed.
Keywords
- -Li YY, Yin ZY, Li S, Xu H, Zhang XP, Cheng H, et al., Comparison of transvaginal surgery and methotrexate/mifepristone-combined transcervical resection in the treatment of cesarean scar pregnancy. Eur Rev Med Pharmacol Sci. 2017 Jun;21(12):2957-2963.
- - Donald L. Fylstra, MD. Ectopic Pregnancy Within a Cesarean Scar: A Review. Obstet Gynecol Surv. 2002;57(8):537-43.
- - Rotas MA, Haberman S, Levgur M.Cesarean Scar Ectopic Pregnancies Etiology, Diagnosis, and Management. Obstet Gynecol. 2006;107(6):1373-81.
- - Chou MM, Hwang JI, Tseng JJ, Huang YF, Ho ES. Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with 3-dimensional color power Doppler imaging and successful treatment with uterine artery embolization. Am J Obstet Gynecol. 2004;190(3):866-8.
- - Valley MT, Pierce JG, Daniel TB, Kaunitz AM. Cesarean scar pregnancy: imaging and treatment with conservative surgery. Obstet Gynecol. 1998;91(5 Pt 2):838-40.
- - Luo L, Ruan X, Li C, Chen S, Hu Q, Mueck AO. Early clinical features and risk factors for cesarean scar pregnancy: a retrospective case-control study. Gynecol Endocrinol. 2018 ;15:1-5.
- - Li YR, Xiao SS, Wan YJ, Xue M. Analysis of the efficacy of three treatment options for cesarean scar pregnancy management. J Obstet Gynaecol Res. 2014;40 (11):2146-51.
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