Broad Ligament Pregnancy Through A Cesarean Scar : An Unusual One

Broad ligament pregnancy is an extremely rare event with high risk of maternal mortality. Diagnosis is often late in our setting and finally made during laparotomy. It is a type of secondary abdominal pregnancy.We present a case which remained undiagnosed throughout her pregnancy till she reached to 35 weeks and unfortunately had intrauterine fetal demise when she reported to our hospital.After admission her pregnancy was induced with misoprostol but did not response. On clinical suspicion,repeat ultrasound evaluation was done by senior sinologist, which picked up the diagnosis of abdominal pregnancy. On laparotomy a broad ligament pregnancy was found with a rent in the previous Cesarean scar towards the gestational sac in the broad ligament.Chatt Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 60-62

Download Full-text

Broad Ligament Pregnancy: Lessons Learnt

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1302 ◽

2014 ◽

Vol 6 (3) ◽

pp. 178-179

Author(s):

Rukshana LNU ◽

Preet Agarwal ◽

Usha Viswanath ◽

MS Natarajan

Keyword(s):

South Asian ◽

Transvaginal Ultrasound ◽

Broad Ligament ◽

Termination Of Pregnancy ◽

Abdominal Pregnancy ◽

Pregnancy Induced Hypertension ◽

Previous Cesarean Section ◽

Lessons Learnt ◽

Induced Hypertension ◽

Previous Cesarean

ABSTRACT Abdominal pregnancy is a rare obstetric condition seen by the obstetricians. Its diagnosis is usually difficult and management is a matter of debate. A 39-year-old multigravida with 20 weeks gestation complicated by pregnancy-induced hypertension, diabetes mellitus and anemia with previous cesarean section was admitted. She was not aware of her pregnancy earlier and she desired termination of pregnancy. But, termination of pregnancy failed inspite of using all possible methods of inducing labor. Diagnosis of abdominal pregnancy was made on by transvaginal ultrasound and proceeded with laparotomy. Left broad ligament pregnancy was found and the sac with fetus extracted. However, due to uncontrollable bleeding from broad ligament during placenta separation and hysterectomy was proceeded in this lady. We present our experience with the diagnosis and management of this rare case. How to cite this article Agarwal P, Viswanath U, Rukshana, Natarajan MS. Broad Ligament Pregnancy: Lessons Learnt. J South Asian Feder Obst Gynae 2014;6(3):178-179.

Download Full-text

Spontaneous Fundal Uterine Rupture in a Pregnant Woman at 32 Weeks Gestation who had Two Previous Cesarean Sections

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2016.488 ◽

2016 ◽

Author(s):

Metin Kaba ◽

Ayşegül Öksüzoğlu ◽

Hakan Timur ◽

Eren Akbaba ◽

Gökçen Kaba ◽

...

Keyword(s):

Case Report ◽

Pregnant Woman ◽

Preterm Delivery ◽

Uterine Rupture ◽

Rare Event ◽

Cesarean Sections ◽

Successful Management ◽

Fetal Demise ◽

Spontaneous Uterine Rupture ◽

Previous Cesarean

<p>Spontaneous uterine rupture during pregnancy can cause severe complications, even maternal and fetal demise. We report successful management of a spontaneous fundal uterine rupture in a 32 week pregnant who had undergone two previous cesarean sections due to preterm delivery. We explain causes of spontaneous uterine rupture and the management of this rare event in the presented case report.</p>

Download Full-text

GROSSESSE ABDOMINALE: A PROPOS D UN CAS

International Journal of Advanced Research ◽

10.21474/ijar01/12307 ◽

2021 ◽

Vol 9 (02) ◽

pp. 338-344

Author(s):

Beya Mohamed Mahmoud lemhaba ◽

◽

Ezza Lemrabot ◽

Nessiba abdelkader Mohamed Zeine. K. Saoud ◽

N. Mamouni ◽

...

Keyword(s):

Peritoneal Cavity ◽

Maternal Morbidity ◽

Oral Contraception ◽

Morbidity Rate ◽

Moderate Pressure ◽

Abdominal Pregnancy ◽

Ultrasound Evaluation ◽

Pelvic Wall ◽

Gestational Sac ◽

Fertilized Egg

Abdominal pregnancy (GA) is defined as the implantation and development of the fertilized egg in the peritoneal cavity. It remains a very rare variety of ectopic pregnancy and can go undetected until late gestational age. Although the fetus may be viable, the maternal morbidity rate is high due to the occurrence of hemorrhages, which complicate management We report the case of a 27-year-old woman, G2P1 under estrogen-progetative oral contraception, having an irregular cycle; consults for abdomino-pelvic pain after 3 months of amenorhea with stable hemodynamics, the cervix is ÃƒÂ¢Ã‚Â€Ã‚Â‹ÃƒÂ¢Ã‚Â€Ã‚Â‹closed and clean she experiences moderate pressure pain in the gastric region. The ultrasound evaluation to objectify an empty uterus with an evolving pregnancy of 11 weeks.The results of the laboratory analyzes are normal, with the exception of a hemoglobin at 10 g / l. A laparotomy allowed the demonstration of the gestational sac in the peritoneal cavity implanted on the pelvic wall adhering to the ovary and the omentum partly broken on extraction.

Download Full-text

A Case of Misdiagnosed Cesarean Scar Pregnancy with a Viable Birth at 28 Weeks

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/375685 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3

Author(s):

Sakiko Nukaga ◽

Shigeru Aoki ◽

Kentaro Kurasawa ◽

Tsuneo Takahashi ◽

Fumiki Hirahara

Keyword(s):

Early Pregnancy ◽

Ultrasound Image ◽

Uterine Cavity ◽

Normal Pregnancy ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Gestational Sac ◽

Previous Cesarean ◽

Made In

We report our experience with a case of presumptive cesarean scar pregnancy, based on detection of a gestational sac (GS) in early pregnancy at the site of a previous cesarean scar. The GS grew into the uterine cavity as the pregnancy progressed, showing an ultrasound image similar to that of a normal pregnancy. Thus, the pregnancy continued, resulting in a viable birth at 28 weeks of gestation. Cesarean scar pregnancy is classified as myometrial implantation or implantation growth into the uterine cavity. In the latter type, the gestational sac moves upward with increasing gestational weeks and it shows the same ultrasound image as a normal pregnancy. Therefore, the diagnosis must be made in the early pregnancy.

Download Full-text

A case report on ruptured interstitial ectopic pregnancy: diagnostic dilemma

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192470 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2567

Author(s):

Suman S. Sharma ◽

A. V. Gokhale ◽

Shonali Agrawal

Keyword(s):

Ectopic Pregnancy ◽

Broad Ligament ◽

Rare Event ◽

Uterine Cavity ◽

Fallopian Tubes ◽

Diagnostic Challenge ◽

Diagnostic Dilemma ◽

Radiological Features ◽

Gestational Sac ◽

Interstitial Ectopic Pregnancy

The ectopic pregnancy occurs when implantation of the blastocyst takes place in a site other than the endometrium of the uterine cavity. Interstitial ectopic pregnancies are gestations that implant within the proximal, intramural portion of the fallopian tubes with high vascularity. Ectopic pregnancy in the interstitial part of the fallopian tubes can be life-threatening considering the thin myometrial tissue surrounding the gestational sac and high vascularization which may result in catastrophic haemorrhage when interstitium is ruptured. Being a hazardous type of ectopic pregnancy, it becomes extremely important to diagnose and manage it. This condition presents a challenge for clinical as well as radiological diagnosis. Generally, a case of interstitial ectopic pregnancy has typical radiological features distinguishing it from other ectopic. The ultrasonographic finding of interstitial line has better sensitivity (80%) and specificity (98%) than eccentric gestational sac location (sensitivity, 40%; specificity, 88%) and myometrial thinning (sensitivity, 40%; specificity, 93%) for the diagnosis of interstitial ectopic pregnancy. Ultrasound is the mainstay of diagnosis, but magnetic resonance imaging can be helpful in unusual or complicated cases. Interstitial ectopic pregnancy rupturing into the leaves of broad ligament and creating a tamponade effect to alter the clinical presentation is a rare event which presents as a diagnostic challenge. Here authors present a case of ruptured interstitial ectopic pregnancy confined to the leaves of broad ligament, with atypical presentation and radiological features which led to difficulty in diagnosing the interstitial ectopic pregnancy. After laparoscopic confirmation of ruptured interstitial ectopic pregnancy, the patient was managed successfully by laparoscopic cornual resection.

Download Full-text

Scar Pregnancy a Diagnostic Conundrum: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.5202 ◽

2021 ◽

Vol 59 (235) ◽

Author(s):

Manoj Pokhrel ◽

Shreedhar Prasad Acharya ◽

Jyotshna Sharma ◽

Meena Thapa

Keyword(s):

Past History ◽

Transvaginal Sonography ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Uterine Incision ◽

History Of ◽

Gestational Sac ◽

High Index Of Suspicion ◽

Prompt Diagnosis ◽

Previous Cesarean

Cesarean scar pregnancy is a rare form of ectopic pregnancy which may lead to uterine rupture and catastrophic hemorrhage. We report a case of cesarean scar pregnancy in a 35-year-old female with the past history of cesarean section presented with complaints of amenorrhoea for 6 weeks and non-specific pain. Two Transvaginal sonography was done 48 hours apart which suggested a cesarean scar pregnancy in one and cervical pregnancy on the other. Magnetic Resonace Imaging showed a well-defined cystic lesion of (21x19)mm2 embedded within the previous cesarean scar which confirmed the diagnosis of cesarean scar pregnancy. Laparotomy unveiled uterus around 6 weeks size and a (3x3)cm2 bulge was noted at the site of previous scar in lower uterine segment, where a small incision was given and the gestational sac was removed following which the uterine incision was closed with 2-0 polyglactin suture. High index of suspicion and prompt diagnosis is ofparamount for reducing morbidity and mortality.

Download Full-text

Rare case of broad ligament pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212688 ◽

2021 ◽

Vol 10 (7) ◽

pp. 2893

Author(s):

Pragya Ojha ◽

Kalika Vaish

Keyword(s):

High Risk ◽

Early Diagnosis ◽

Maternal Morbidity ◽

Rare Case ◽

Broad Ligament ◽

Exploratory Laparotomy ◽

Abdominal Pregnancy ◽

Lower Abdomen ◽

Rare Form ◽

Maternal Morbidity And Mortality

Broad ligament pregnancy is rare form of abdominal pregnancy. There is high risk of maternal morbidity and mortality. Due to its rarity, usually, diagnosis cannot be established before surgery. We reported a 27 year old, G3P2L2 who presented with 4 month amenorrhea with pain in lower abdomen. Ultrasonography revealed a single live extra-uterine pregnancy of 17 weeks in right adnexa. A right sided Broad ligament pregnancy was found on exploratory laparotomy. Excision of mass with right sided salpingo-oophrectomy was performed. Post operative course was uneventful. Early diagnosis with high risk of suspicion and early intervention is needed to overcome it’s related complications.

Download Full-text

Risk factors for poor hemostasis of prophylactic uterine artery embolization before curettage in cesarean scar pregnancy

Journal of International Medical Research ◽

10.1177/0300060520964379 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096437

Author(s):

Hongan Tian ◽

Shunzhen Li ◽

Wanwan Jia ◽

Kaihu Yu ◽

Guangyao Wu

Keyword(s):

Risk Factors ◽

Blood Supply ◽

Uterine Artery Embolization ◽

Uterine Artery ◽

Embolic Agent ◽

Artery Embolization ◽

Cesarean Scar Pregnancy ◽

Cesarean Scar ◽

Hemorrhage Volume ◽

Gestational Sac

Objective To observe the hemostatic effect of prophylactic uterine artery embolization (UAE) in patients with cesarean scar pregnancy (CSP) and to examine the risk factors for poor hemostasis. Methods Clinical data of 841 patients with CSP who underwent prophylactic UAE and curettage were retrospectively analyzed to evaluate the hemorrhage volume during curettage. A hemorrhage volume ≥200 mL was termed as poor hemostasis. The risk factors of poor hemostasis were analyzed and complications within 60 days postoperation were recorded. Results Among the 841 patients, 6.30% (53/841) had poor postoperative hemostasis. The independent risk factors of poor hemostasis were gestational sac size, parity, embolic agent diameter (>1000 μm), multivessel blood supply, and incomplete embolization. The main postoperative complications within 60 days after UAE were abdominal pain, low fever, nausea and vomiting, and buttock pain, with incidence rates of 71.22% (599/841), 47.44% (399/841), 39.12% (329/841), and 36.39% (306/841), respectively. Conclusions Prophylactic UAE before curettage in patients with CSP is safe and effective in reducing intraoperative hemorrhage. Gestational sac size, parity, embolic agent diameter, multivessel blood supply, and incomplete embolization of all arteries supplying blood to the uterus are risk factors of poor hemostasis.

Download Full-text