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

2020 ◽  
Vol 9 (11) ◽  
pp. 4773
Author(s):  
Priti Agrawal ◽  
Rishi Agrawal ◽  
Sujeet Agrawal
Keyword(s):  
Abdominal Pain ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Hypovolemic Shock ◽  
Hemodynamic Instability ◽  
Cervix Uteri ◽  
Abdominal Ultrasonography ◽  
Presenting Symptoms ◽  
Caesarean Scar

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.

scholarly journals Cesarean Scar Ectopic Pregnancy

2021 ◽  
Vol 11 (5) ◽  
pp. 358-361
Author(s):  
Sunil V. Jagtap ◽  
Nitin Kshirsagar ◽  
Ramnik Singh
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Uterine Rupture ◽  
Vaginal Bleeding ◽  
Hypovolemic Shock ◽  
Lower Uterine Segment ◽  
Caesarean Scar ◽  
Anterolateral Wall ◽  
History Of ◽  
Gestational Sac

Caesarean Scar Ectopic Pregnancy (CSEP) is one of the rarest forms of ectopic pregnancy. We present a 30 year female presented with 8 weeks of amenorrhea. Her obstetric history was G3P2D2. Her B HCG levels were >10,000 IU/L. She had history of previous 2 lower uterine segment Caesarean section. She was referred to our hospital in stage of severe hypovolemic shock related to vaginal bleeding. USG findings were suggestive of death of fetus of about 6 weeks 5 days. Gestational -sac at lower uterine segment Caesarean section scar level. Radiological diagnosis was? Scar pregnancy. On histopathology diagnosed as Caesarean scar ectopic pregnancy with area of rupture in anterolateral wall of lower uterine segment and upper cervix. The endometrium was unremarkable. We are presenting this case for its rarity, clinical radiological and histopathological findings. Key words: Scar ectopic pregnancy, Uterine rupture, Gestation, Caesarean section.

scholarly journals Study on Risk Factors, Clinical Presentation & Operative Management of Ectopic Pregnancy

2016 ◽  
Vol 28 (1) ◽  
pp. 9-14
Author(s):  
Kamrun Nahar ◽  
Turani Talukder ◽  
Sabiha Sultana ◽  
Md Anwar Hossain
Keyword(s):  
Risk Factors ◽  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Operative Management ◽  
Age Group ◽  
Presenting Symptoms ◽  
Patient Profile ◽  
Short Period ◽  
History Of ◽  
Acute Condition

Introduction: Ectopic pregnancy is a major clinical problem in gynaecology because it is often difficult to diagnose as the patient present in different ways. An accurate history taking and physical examination is considered to be most important in the diagnosis of ectopic pregnancy. There are two treatment options, medical or surgical. Surgical treatment is the fastest treatment for ectopic pregnancy though surgical management decreased from approximately 90% to 65%1. Surgery may be the only treatment option if there is internal bleeding. In the medical treatment group, 15% of cases were categorized as failures and required surgery1.Objectives: This study was conducted in the department of obst and Gynae of Dhaka Medical College Hospital from January 2005 to June 2005 in an attempt to find out the risk factors of ectopic pregnancy, the way of presentation and to analyze the operative treatment of ectopic pregnancy.Materials and Methods: A total 50 consecutive patients who were clinically suspicious of ectopic pregnancy were included in this study between January 2005 to June 2005. Patients who were clinically suspicious of EP and also supported by positive urinary pregnancy tests, beta hCG and no intrauterine gestational sac in ultrasonography were included in this study. Detailed discussion about the study was done with the patient and then informed verbal consent was taken from them. Detailed history about patient profile, presenting symptoms, any risk factors and clinical examination done and the findings were recorded in the predesigned data collection sheet. Data was expressed in terms of frequencies and percentagesResults: Most of the patients were in the age group of 20-30 years and 38% of low parity (para- 1).Previous miscarriage, infertility,IUCD users and PID identified as the risk factors of ectopic pregnancy— 42% patients had history of previous abortion or MR, period of infertility 22%, pelvic infection 12%, IUCD users 16%. In this study acute abdominal pain after a short period of amenorrhoea was found to be the main symptoms in ectopic pregnancy—100% patients were presented with lower abdominal pain, 70% with period of amenorrhea and 50% patients with per vaginal bleeding. All the patients were presented with acute condition and were surgically managed fastest treatment. At the time of operation 84% of ectopic tubal pregnancy were found ruptured, 10% were tubal abortion and 4% unruptured. Sites of ectopic pregnancy were ampullary 50%, isthmic 20%, fimbrial 10%.Conclusion: Most of the patient presented in acute condition with the classical features of ruptured ectopic pregnancy. Near half of the patient were in younger age group (26 – 30 years) having risk factors like history of previous abortion/MR 42%, infertility 22% use of IUCD 16%, PID 12%. More then three forth( 84%) of cases were diagnosed as ruptured ectopic during operation. Operative management was done on the basis of site of ectopic and parity of the womanBangladesh J Obstet Gynaecol, 2013; Vol. 28(1) : 9-14

CAESAREAN SCAR ECTOPIC -A RARE ENTITY

2021 ◽  
pp. 28-29
Author(s):  
Naina Yadav ◽  
Kalpana Tiwari ◽  
Priyanka Goel
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Previous Caesarean Section ◽  
Rare Entity ◽  
Caesarean Scar ◽  
Caesarean Scar Pregnancy

Caesarean scar pregnancy (CSP) is an ectopic pregnancy implanted in (1) the myometrium at the site of a previous caesarean section scar Its incidence is rising with the increase in number of caesarean sections .Very rst case was reported in 1978

scholarly journals Ruptured Ectopic Pregnancy in the Presence of an Intrauterine Device

2019 ◽  
Vol 3 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Matthew Neth ◽  
Maxwell Thompson ◽  
Courtney Gibson ◽  
John Gullett ◽  
David Pigott
Keyword(s):  
Abdominal Pain ◽  
Maternal Mortality ◽  
Ectopic Pregnancy ◽  
Female Patient ◽  
Vaginal Bleeding ◽  
Intrauterine Device ◽  
First Trimester ◽  
Equal Protection ◽  
Intrauterine Pregnancy

Ruptured ectopic pregnancy is the leading cause of first trimester maternal mortality. The diagnosis of ectopic pregnancy should always be suspected in patients with abdominal pain, vaginal bleeding or syncope. While the use of an intrauterine device (IUD) markedly reduces the incidence of intrauterine pregnancy, it does not confer equal protection from the risk of ectopic pregnancy. In this report we discuss the case of a female patient who presented with a ruptured ectopic pregnancy and hemoperitoneum despite a correctly positioned IUD.

scholarly journals Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age

2019 ◽  
Vol 3 (1) ◽  
pp. 62-64 ◽  
Author(s):  
Justine Stremick ◽  
Kyle Couperus ◽  
Simeon Ashworth
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
First Trimester ◽  
Second Trimester ◽  
Intrauterine Pregnancy ◽  
Tubal Ectopic Pregnancy ◽  
Ectopic Pregnancies ◽  
First Trimester Ultrasound

Tubal ectopic pregnancies are commonly diagnosed during the first trimester. Here we present a second-trimester tubal ectopic pregnancy that was previously misdiagnosed as an intrauterine pregnancy on a first-trimester ultrasound. A 39-year-old gravida 1 para 0 woman at 15 weeks gestation presented with 10 days of progressive, severe abdominal pain, along with vaginal bleeding and intermittent vomiting for two months. She was ultimately found to have a ruptured left tubal ectopic pregnancy. Second-trimester ectopic pregnancies carry a significant maternal mortality risk. Even with the use of ultrasound, they are difficult to diagnose and present unique diagnostic challenges.

scholarly journals Caesarean Scar Pregnancy - A Rare Case Report

2016 ◽  
Vol 27 (2) ◽  
pp. 83-86 ◽  
Author(s):  
Razia Sultana ◽  
Saiful Islam ◽  
Nurjahan
Keyword(s):  
Case Report ◽  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Transvaginal Sonography ◽  
Emergency Laparotomy ◽  
Colour Doppler ◽  
Caesarean Scar ◽  
Incomplete Abortion ◽  
Rare Case Report ◽  
Life Threatening

Objective:The aim is to publish the case report of the rarely occurring and life threatening ectopic pregnancy developing in a Caesarean section scar causing uterine rupture.Methods and Results: This patient was diagnosed initially as a case of incomplete abortion. Other possible diagnoses were molar pregnancy, mass in the cervix. She was admitted in hospital for evacuation and curettage. During the procedure she developed severe pervaginal bleeding leading to hypovolumic shock. So decision was taken for emergency laparotomy. After opening the abdomen rupture was found in the lower uterine segment extending upto upper part of cervix. So hysterectomy was performed and histopathology confirmed the diagnosis of ectopic pregnancy that developed in a Caesarean section scar Analysis of the women’s obstetric history revealed that she had been previously operated because of breech presentation.Conclusion: Heightened awareness of the possibility of pregnancy in caesarean scar and early diagnosis by means of transvaginal sonography along with colour doppler can improve outcome and minimize the need for emergency extended surgeryBangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 83-86

scholarly journals Caesarean scar endometriosis

2021 ◽  
Vol 10 (11) ◽  
pp. 4331
Author(s):  
Garima Kumari
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Caesarean Section ◽  
Lower Abdominal Pain ◽  
Clinical History ◽  
Lower Segment ◽  
Scar Endometriosis ◽  
Lower Segment Caesarean Section ◽  
Caesarean Scar ◽  
Menstrual History

 Endometriosis is defined by the presence and growth of ectopic functional endometrial tissue outside the uterus. The symptoms are nonspecific, typically involving abdominal wall pain at the time of menstruation. It commonly follows obstetrical and gynecological surgeries. The diagnosis is frequently made only after excision of scar the diseased tissue. A case report of 34 year old female patient presenting with scar endometriosis 7 years after her last LSCS (lower segment caesarean section). The patient came with the complaint of supra pubic swelling since 6 months, which was growing slowly. Her menstrual history was regular, but she had lower abdominal pain during menstruation. On clinical history, examination and USG finding the swelling was diagnosed as scar endometriosis.

Early pregnancy care

2017 ◽  
Keyword(s):  
Caesarean Section ◽  
Ectopic Pregnancy ◽  
Fallopian Tube ◽  
Early Pregnancy ◽  
Vaginal Bleeding ◽  
Clinical Skills ◽  
Management Plan ◽  
Pregnancy Test ◽  
Assessment Task ◽  
Urine Pregnancy Test

This task assesses the following clinical skills: … ● Patient safety ● Communication with patients and their relatives ● Information gathering ● Applied clinical knowledge … You are an ST4 doctor covering Early Pregnancy Assessment Unit (EPAU). You have been asked to see 24- year- old Jaz Pringle in her third pregnancy. Her LMP was six weeks ago and has presented with left iliac fossa pain and light vaginal bleeding. Your task is: … ● To take a focussed history ● Organize the necessary investigations ● Discuss the results and diagnosis with Jaz ● Agree a management plan … You have 10 minutes for this task (+ 2mins initial reading time). This is a communication skills clinical assessment task that tests the candidate’s skills to take a focussed history, interpret and explain results and agree to a management plan having discussed the options. If they ask for the urine pregnancy test, tell them it is positive. If they arrange an ultrasound, provide them with the following result. ‘An empty uterus and a 2.3cm left sided adnexal mass with well- defined gestational sac medial to the left ovary with minimal fluid in pouch of Douglas. Right ovary appeared normal. Findings are highly suggestive of left sided tubal pregnancy’. If they organize beta HCG, tell them the nurse had sent it and the result is back and it is 2900IU/ml. Record your overall clinical impression of the candidate for each domain (e.g. should this performance be pass, borderline, or a fail). You are Ms. Jaz Pringle, a 24- year- old housewife who lives with her partner of four years. You have one child delivered by caesarean section for breech (bottom first) presentation three years ago. You had developed infection post caesarean section and were very unwell. You had needed admission to the hospital for 10 days and needed IV antibiotics. This was followed by an ectopic pregnancy 18 months ago whereby you ended up having key hole surgery and removal of your right fallopian tube with ectopic pregnancy. While you have not been actively trying for another pregnancy, you and your partner are happy with the thought of another pregnancy. However, you attended hospital due to some discomfort on the left side of the tummy and some vaginal bleeding on and off for two days. You are otherwise fit and well with no allergies. The candidate should arrange a urine pregnancy test, which will be positive. They should then organize a scan in the EPAU. The scan will suggest an ectopic pregnancy in your right tube. You are now extremely upset and anxious after the scan at the thought of possibly losing the only remaining tube and being rendered infertile. You want to know all possible options and would like to save the only fallopian tube if possible.

scholarly journals Experience with Ectopic Pregnancy in a Tertiary Care Teaching Hospital

2018 ◽  
Vol 27 (2) ◽  
pp. 22-26
Author(s):  
NA Parveen ◽  
MM Sarker ◽  
MK Sarker
Keyword(s):  
Abdominal Pain ◽  
Ectopic Pregnancy ◽  
Vaginal Bleeding ◽  
Tertiary Care ◽  
Lower Abdominal Pain ◽  
Reproductive Age ◽  
Age Group ◽  
Treatment Morbidity ◽  
Incidence Risk ◽  
Abnormal Vaginal Bleeding

Ectopic pregnancy is a common life-threating condition. Diagnosis is frequently missed and should be considered in any women in the reproductive age group presenting with abdominal pain or vaginal bleeding. This prospective observational study was conducted in RMCH to determine the incidence, risk factors, clinical presentation, treatment, morbidity and mortality associated with ectopic pregnancy. A total of 50 cases of ectopic pregnancy were operated during the study period giving the incidence of ectopic pregnancy of 8.02/1000 pregnancies. The age of the patient ranged from 18-37 years, with maximum (40%) between 26-30 years age group. 36% patients had delivered one child and 24% were nulliparous. 30% patients had pelvic inflammatory disease and 22% had history of previous abortion/ MR. All patients presented with lower abdominal pain, 68% presented with abnormal vaginal bleeding and 60% had amenorrhoea. Most of the patients were diagnosed by high clinical suspicion and confirmed by USG. 96% cases ectopic pregnancy occurred in the fallopian tube and ampullary part was mainly affected. Laparotomy followed by unilateral salphingectomy was performed in majority (60%) of cases. 22% cases ipsilateral salpingectomy with tubectomy other side and 12% cases salpingostomy were performed. The recovery of majority of patients was smooth and uneventful. There was no death in this study.TAJ 2014; 27(2): 22-26

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