Farname Inc. in collaboration with Iranian Society of Gynecology Oncology

Authors

1 Gynecologist Oncologist, Associate Professor, Department of Obstetrics and Gynecology, Women’s Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

2 Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: The prevalence of ectopic pregnancy is 1 to 2% and a previous cesarean section scar ectopic pregnancy or hysterectomy occurs as rare as 1 per 2000 pregnancies. In the current case report, the authors introduced ectopic pregnancy in cesarean scar with unstable hemodynamic condition and surgical management to preserve uterus.
Case Presentation: A 31-year-old pregnant female in the 9th week of pregnancy was admitted with vaginal bleeding and slight pain in the hypogastrium. The cesarean scar pregnancy was confirmed by sonography. In the course of hospitalization, due to the patient’s hemodynamic instability, the emergency laparotomy was performed. In the previous cesarean section scar, a 3 × 4 cm mass with a massive hematoma was found. It was removed and placental bed was sutured. Since the vaginal bleeding continued, the uterine artery ligation was carried out and due to severe bleeding, Foley catheters were packed inside the uterus. Two days later, the patient was discharged from the hospital in good general condition.
Conclusions: Despite the rarity of ectopic pregnancies in the previous cesarean section scars, paying attention and having this kind of pregnancy in mind can aid its early diagnosis and reduce possible morbidity and mortality including uterine rupture and severe bleeding, which can be considered as its irreversible complications.

Keywords

  1. 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. [DOI:10.1016/S0029-7844(97)00426-2]
  2. Hasanzadeh M, Hoseini E, Farazestanian M, Boroumand M. Ectopic pregnancy in the previous cesarean scar (A Case Report). Iran J Obstet Gyn Infertil. 2015;18(153):20-4.
  3. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373-81. [DOI:10.1097/01.AOG.0000218690.24494.ce] [PMID]
  4. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114(3):253-63. [DOI:10.1111/j.1471-0528.2006.01237.x] [PMID]
  5. Ginath S, Malinger G, Golan A, Shahmurov M, Glezerman M. Successful laparoscopic treatment of a ruptured primary abdominal pregnancy. Fertil Steril. 2000;74(3):601-2. [DOI:10.1016/S0015-0282(00)00686-5]
  6. Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000;16(6):592-3. [DOI:10.1046/j.1469-0705.2000.00300-2.x] [PMID]
  7. Graesslin O, Dedecker FJ, Quereux C, Gabriel R. Conservative treatment of ectopic pregnancy in a cesarean scar. Obstet Gynecol. 2005;105(4):869-71. [DOI:10.1097/01.AOG.0000141569.75297.44] [PMID]
  8. Armstrong V, Hansen WF, Van Voorhis BJ, Syrop CH. Detection of cesarean scars by transvaginal ultrasound. Obstet Gynecol. 2003;101(1):61-5. https://doi.org/10.1016/S0029-7844(02)02450-X [DOI:10.1097/00006250-200301000-00014]
  9. Monteagudo A, Carreno C, Timor-Tritsch IE. Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar. J Ultrasound Med. 2001;20(10):1105-15. [DOI:10.7863/jum.2001.20.10.1105] [PMID]
  10. Tulpin L, Morel O, Malartic C, Barranger E. Conservative management of a Cesarean scar ectopic pregnancy: a case report. Cases J. 2009;2:7794. [DOI:10.4076/1757-1626-2-7794] [PMID]
  11. Hudecek R, Felsingerova Z, Felsinger M, Jandakova E. Laparoscopic Treatment of Cesarean Scar Ectopic Pregnancy. J Gynecol Surg. 2014;30(5):309-11. [DOI:10.1089/gyn.2014.0005] [PMID]
  12. Ofili-Yebovi D, Ben-Nagi J, Sawyer E, Yazbek J, Lee C, Gonzalez J, et al. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008;31(1):72-7. [DOI:10.1002/uog.5200] [PMID]
  13. Sadeghi H, Rutherford T, Rackow BW, Campbell KH, Duzyj CM, Guess MK, et al. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J Perinatol. 2010;27(2):111-20. [DOI:10.1055/s-0029-1224874] [PMID]
  14. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23(3):247-53. [DOI:10.1002/uog.974] [PMID]
  15. Riaz RM, Williams TR, Craig BM, Myers DT. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging. 2015;40(7):2589-99. [DOI:10.1007/s00261-015-0472-2] [PMID]