CASE OF SCAR PREGNANCY MISDIAGNOSED FIRST AS INEVITABLE MISCARRIAGE
DR FAUZIA FATIMA (DR FAUZIA AYAZ), DR MARDI OSMAN
(Prince Sultan Armed Forces Hospital, Taif, Saudi Arabia)
OBJECTIVE:
We report a case of scar pregnancy which is first diagnosed as a case of inevitable miscarriage. Scar pregnancy is uncommon butif its diagnoses is missed it can
lead to significant morbidity or mortality.
CASE REPORT:
30-year-old, G3, Para 1+1 previous 1 caesarean section came to emergency department as 7 weeks intrauterine pregnancy with bleeding p/v, on speculum
examination,OSwas open and products seen at upper part of the cervix.On ultrasound no fetal heartbeat was appreciated so she was diagnosed as a case of
missed miscarriage presented as inevitable miscarriage. As bleeding was mild so she was admitted in ward and advised stat dose of misoprostol.
But she didn’t pass out products of conception, so consultant advised for evacuation of products under general anesthesia. Registrar started evacuation as routine
and as soon as the products were pulled with sponge holding forceps, Patient started to have intractable bleeding, consultanton call was called, at first
consultant tried to stop the bleeding by compression methods, but failed, so provisional diagnoses of scar pregnancy with scar rupture was made and immediate
laparotomy was done and uterine cavity opened and scar pregnancy was removed and homeostasis was made with difficulty. Bilateraluterine artery ligation done
and then vertical compression sutures applied on uterus. Abdomen was closed and 2 units of packed RBC’S were transfused.
DISCUSSION:
In this case there is a delay in diagnoses of scar pregnancy as from the beginning on speculum examination OS was open and products seen at upper part of the
cervix so misdiagnosed as inevitable. Later on, diagnosed when she was in operation room for evacuation when she started bleeding excessively, as morning time,
so consultant was around and the patient was managed properly without any delay.
CONCLUSION:
Scar pregnancy should be considered as a possibility in any cases where pregnancy sac is seen in lower part of uterine cavityonscan with history of previous
caesarian section.Correct diagnosis with efficient management can prevent possible complications.