Caesarean Scar Ectopic Pregnancy or Cervico-Isthmical Pregnancy: A Maternal Near Miss

Clinical Image

Austin Med Sci. 2018; 3(2): 1025.

Caesarean Scar Ectopic Pregnancy or Cervico-Isthmical Pregnancy: A Maternal Near Miss

Dasari P*, Ashraf Ali M, Maurya DK and Chtra T

1Department of OBGY, WCH, India

*Corresponding author: Dasari P, Department of OBGY, WCH, JIPMER, Puducherry, India

Received: June 07, 2018; Accepted: June 14, 2018; Published: June 21, 2018

Clinical Image

A 25 year old Gravida3 para2 with history of previous 2 lower segment caesarean sections was diagnosed as 8 weeks of intrauterine pregnancy by USG and she sought MTP with sterilisation. Suction evacuation was abandoned due to profuse haemorrhage suspecting cervical pregnancy.

Subsequent USG showed empty fund us and bulging and enlargement at the lower part of uterus (isthmus) with gestational sac and the cervix was short and the internal Os was not delineated. Hence a diagnosis of cervico-isthmical pregnancy was made and she received 2 Cycles of Variable dose methotrexate along with Mifepristone and underwent uterine artery embolization. After 42 days the vascularise persisted Figure 1 and her serum β HCG declined to 88 m IU/dl. From 28,000 IU/d. She underwent instrumental evacuation and received 3rd course of variable methotrexate along with mifepristone. Subsequent resolution and confirmation of cervico-isthmical pregnancy is shown in Figures 2-5.