Title: Clinical Profile and Outcome of Caesarean Scar Pregnancy in a Tertiary Care Center - A One Year Study
Authors: Dr Sreelatha. S, Dr Manjula M, Dr C.Nirmala
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.76
Abstract
Caesarean scar ectopic is a rare but significant variant of ectopic pregnancy where the implantation is in the cesarean scar.
Objective: To study the clinical profile and outcome of cesarean scar pregnancy during the year 2016 in the department of O&G, Government Medical College Thiruvananthapuram.
Results: Among 8520 deliveries in 2016 there were 8 cases of cesarean scar ectopic pregnancies. Majority were third gravida with history of previous one cesarean delivery. Mean age of the patients was 30 years. The gestational age of diagnosis was between 6-7weeks in 75% of the cases. Only half of the patients were primarily diagnosed as scar ectopic. Two patients were successfully treated with systemic methotrexate. Two directly underwent laparotomy and scar excision, one for impending rupture and the other at the request of the patient for sterilization. Rest were initially misdiagnosed as missed abortion. After failed medical abortion, two were diagnosed as scar ectopic in repeat sonogram. Both of them responded to systemic methotrexate, but was not willing for follow up and so underwent laparotomy. In the other two patients after failed medical abortion, surgical evacuation was done. This resulted in profuse hemorrhage necessitating laparotomy which confirmed scar pregnancy in both the cases.
Conclusion: The implantation site of pregnancy in a scarred uterus is significant. Most of the time scar ectopic is misdiagnosed as normal intra uterine pregnancy or missed abortion and managed accordingly. This can result in unforeseen complications like severe hemorrhage, uterine perforation necessitating emergency laparotomy and multiple blood transfusions and even hysterectomy. If scar ectopic pregnancy is timely diagnosed there are various options for conservative management.
Keywords: Cesarean Scar Ectopic, Systemic Methotrexate, Scar pregnancy excision.
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