SUCCESSFUL MANAGEMENT Of CAESARIAN SCAR ECTOPIC PREGNANCY

Author –  Dr.  Sweeti  Pawar

Introduction 

       Scar ectopic pregnancy is  one of  the rare pregnancy type . Incidence of it   ranging between 1:1800 to 1:2500 pregnancies .In 1978  ,the first case of a caesarean scar ectopic pregnancy was reported . With increasingly high rate of caesarean section deliveries , cases of scar ectopic are rising proportionately . 

Objective 

To discuss diagnosis and  management  of scar ectopic pregnancy .

Case report 

     34 yrs old , G3P2L2 presented as emergency case with abdominal pain , per vaginal bleeding on and off , dropping haemoglobin levels with early pregnancy ultrasound suggestive of uterine cesarian scar pregnancy .On history narrative ,patient had already received  for injection methotrexate from her previous treating hospital and was on monitoring  for serum beta hcg and clinical symptoms .Considering the clinical scenario with borderline vitals , suspicion of rupturing scar ectopic was high .Patient refused any laparoscopic intervention . Emergency laparotomy was performed . Intraoperative findings confirmed hemoperitoneum partial scar rupture with scar dehiscence in area of adhesions . After adhesiolysis and bladder dissection , the ectopic pregnancy was identified  and removed followed by reinforcing sutures at the uterine scar site .Needful blood transfusion and postoperative monitoring and care resulted in appropriate recovery of the patient . 

Discussion 

Ectopic pregnancy is a significant contributor to maternal morbidity and mortality . Especially scar ectopic cases are demanding from diagnostic and therapeutic perspective .Prompt diagnosis and apt management significantly reduce maternal morbidity and mortality .

Conclusion 

Appropriate use of imaging techniques ( ultrasound )  empowered with  monitoring   and surgical proficiency  play a key role in reduction of maternal mortality and morbidity due to scar  ectopic pregnancy . 

Key words 

Caesarian  Scar ,  ectopic , laparotomy , hemoperitoneum , uterine scar rupture , uterine scar dehiscence , Uterine scar reinforcement