European Journal of Molecular & Clinical Medicine

Abstract

Introduction: This term describes implantation within the myometrium of a prior cesarean delivery scar. Its incidence approximates 1 in 2000 normal pregnancies and has increased along with the cesarean delivery rate. It is rarest of all ectopic pregnancies. It is a life threatening condition, causes excessive haemorrhage and risk of uterine rupture.
Case Summary: A 35 year old female, presented to OBG Department with complaints of Per Vaginal spotting since 3 days (with less than half pad soaked) and lower abdominal pain since 3 days, UPT was positive. Her obstetric score was Gravida 4 Para 2 Living 2 Abortion 1 with 6 weeks of amenorrhea. On eliciting her obstetric history, her married life was 10 years. She had history of one spontaneous abortion at 2 months of gestation for which a dilatation & evacuation was done. She had 2 previous Caesarian sections indicated because of low lying placenta and previous caesarean respectively. On Per abdomen examination, previous LSCS scar was seen and on palpation abdomen was soft and non tender with no scar tenderness. On per speculum examination minimal bleed was seen on the cervical os. On per Vaginal examination - uterus was normal in size, retroverted and bilateral fornices were free and non tender. An urgent USG OBS was advised, which showed- A gestational sac in the lower uterine segment along the anterior wall, with thinning of anterior myometrial wall. Adjacent to the sac, an heterogenous echogenicity was seen - likely previous LSCS scar. Hysteroscope port with camera was put into the cervix, a gestational sac with clots adjacent to it was seen over the anterior uterine wall over the lower segment of uterus. Curetting was done and products were removed. Patient was discharged within 8 hours and was asked to follow up after 1 week with an USG abdomen pelvis which was normal, and showed no RPOC or any other significant abnormality.