Arch Gynecol Obstet DOI 10.1007/s00404-014-3206-8
Case Report
Caesarean scar pregnancy: hysterotomy is rapid and safe management option Mohamed Ali Abdelkader · Reham Fouad · Amr Hosny Gebril · Mohamed Ahmed El Far · Dina Fauzi Elyassergi
Received: 14 February 2014 / Accepted: 28 February 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Caesarean scar pregnancy (CSP) is implantation of the gestational sac within the hysterotomy scar. Ultrasound is the main diagnostic tool. Early diagnosis and termination of pregnancy is crucial to avoid the risk of uterine rupture. The termination modalities available are dilatation and curettage, methotrexate therapy, hysteroscopy, uterine artery embolization and laparotomy. We present a case of undisturbed CSP which presented at 6 weeks + 6 days gestation. Our management was termination of pregnancy by exploratory laparotomy and hysterotomy for excision of the mass. The postoperative period was uneventful and there was rapid decline of beta human chorionic gonadotrophin to the normal level. Keywords Caesarean section · Scar · Pregnancy · Hysterotomy
Introduction Caesarean scar pregnancy (CSP) is defined as implantation of the gestational sac in the hysterotomy scar [1]. 751 cases of CSP are identified in a recent literature search [2]. The incidence of CSP is estimated to be 1:2,226 of all pregnancies [3], and occurs at a rate of 0.15 % in women with a
M. A. Abdelkader · R. Fouad (*) · A. H. Gebril · M. A. El Far Department of Obstetrics and Gynecology, Cairo University, 28 al arkam ibn abi al arkam street, Al meraj, al maadi, Cairo, Egypt e-mail: [email protected] D. F. Elyassergi Department of Pathology, Cairo University, 28 al arkam ibn abi al arkam street, Al meraj, al maadi, Cairo, Egypt
previous CS and at a rate of 6.1 % of all ectopic pregnancies in women who had at least one CS [3]. Termination of CSP is strongly recommended due to the risk of uterine rupture if expectant management is allowed [3]. A 26-year-old patient gravida 4, para 3, was referred to Cairo University teaching hospital (a large tertiary center with 5,500 beds) with confirmed pregnancy of 6 weeks + 6 days gestation as a case of suspected ectopic pregnancy. She had serial beta human chorionic gonadotrophin (β hCG) of 1,500 mIU/ml increased to 1,900 mIU/ ml after 48 h. Last β hCG was 6,600 mIU/ml 1 day before presentation. The patient gave history of one CS 5 months back. She was vitally stable and had no history of either abdominal pain or vaginal bleeding. Transvaginal ultrasound (TVUS) revealed empty uterine cavity and empty cervical canal. A gestational sac (2 cm) without fetal pole was seen within the myometrium of the anterior uterine wall (supracervical to the right) (Figs. 1, 2). The choice of surgical management was taken. Exploratory laparotomy was done. The visceral peritoneum was incised at the uterovesical pouch and the urinary bladder was dissected downwards. The supracervical mass at the site of the previous CS scar to the right (2 × 3 cm) was identified (Fig. 3). Excision of the mass with the adjacent myometrium was done by an elliptical hysterotomy incision. A branch of the right uterine artery was accidentally injured. Hemostasis of this branch was achieved by hemostatic sutures. Finally the uterine incision was closed in two layers. Post operative period passed uneventfully and the patient did not need any blood transfusion. Follow up β hCG was 1,013 mIU/ml 48 h after surgery, dropped to 75 mIU/ml 1 week later and was
Case Report
Caesarean scar pregnancy: hysterotomy is rapid and safe management option Mohamed Ali Abdelkader · Reham Fouad · Amr Hosny Gebril · Mohamed Ahmed El Far · Dina Fauzi Elyassergi
Received: 14 February 2014 / Accepted: 28 February 2014 © Springer-Verlag Berlin Heidelberg 2014
Abstract Caesarean scar pregnancy (CSP) is implantation of the gestational sac within the hysterotomy scar. Ultrasound is the main diagnostic tool. Early diagnosis and termination of pregnancy is crucial to avoid the risk of uterine rupture. The termination modalities available are dilatation and curettage, methotrexate therapy, hysteroscopy, uterine artery embolization and laparotomy. We present a case of undisturbed CSP which presented at 6 weeks + 6 days gestation. Our management was termination of pregnancy by exploratory laparotomy and hysterotomy for excision of the mass. The postoperative period was uneventful and there was rapid decline of beta human chorionic gonadotrophin to the normal level. Keywords Caesarean section · Scar · Pregnancy · Hysterotomy
Introduction Caesarean scar pregnancy (CSP) is defined as implantation of the gestational sac in the hysterotomy scar [1]. 751 cases of CSP are identified in a recent literature search [2]. The incidence of CSP is estimated to be 1:2,226 of all pregnancies [3], and occurs at a rate of 0.15 % in women with a
M. A. Abdelkader · R. Fouad (*) · A. H. Gebril · M. A. El Far Department of Obstetrics and Gynecology, Cairo University, 28 al arkam ibn abi al arkam street, Al meraj, al maadi, Cairo, Egypt e-mail: [email protected] D. F. Elyassergi Department of Pathology, Cairo University, 28 al arkam ibn abi al arkam street, Al meraj, al maadi, Cairo, Egypt
previous CS and at a rate of 6.1 % of all ectopic pregnancies in women who had at least one CS [3]. Termination of CSP is strongly recommended due to the risk of uterine rupture if expectant management is allowed [3]. A 26-year-old patient gravida 4, para 3, was referred to Cairo University teaching hospital (a large tertiary center with 5,500 beds) with confirmed pregnancy of 6 weeks + 6 days gestation as a case of suspected ectopic pregnancy. She had serial beta human chorionic gonadotrophin (β hCG) of 1,500 mIU/ml increased to 1,900 mIU/ ml after 48 h. Last β hCG was 6,600 mIU/ml 1 day before presentation. The patient gave history of one CS 5 months back. She was vitally stable and had no history of either abdominal pain or vaginal bleeding. Transvaginal ultrasound (TVUS) revealed empty uterine cavity and empty cervical canal. A gestational sac (2 cm) without fetal pole was seen within the myometrium of the anterior uterine wall (supracervical to the right) (Figs. 1, 2). The choice of surgical management was taken. Exploratory laparotomy was done. The visceral peritoneum was incised at the uterovesical pouch and the urinary bladder was dissected downwards. The supracervical mass at the site of the previous CS scar to the right (2 × 3 cm) was identified (Fig. 3). Excision of the mass with the adjacent myometrium was done by an elliptical hysterotomy incision. A branch of the right uterine artery was accidentally injured. Hemostasis of this branch was achieved by hemostatic sutures. Finally the uterine incision was closed in two layers. Post operative period passed uneventfully and the patient did not need any blood transfusion. Follow up β hCG was 1,013 mIU/ml 48 h after surgery, dropped to 75 mIU/ml 1 week later and was
