Ectopic pregnancy in scar from a previous cesarean: case report
DOI:
https://doi.org/10.37497/JMRReview.v1i1.18Keywords:
Ectopic Pregnancy, Case Report, Cesarean Scar, Obstetric ManagementAbstract
Background: Ectopic pregnancy should be considered in any pregnant patient with vaginal bleeding or lower abdominal pain when intrauterine pregnancy has not yet been established. More than 95% of ectopic pregnancies occur in the tubes, especially the ampullary portion with 70% of cases. Other sites reported for ectopic pregnancies, although of marked rarity, are the abdomen, ovary and scar from a previous cesarean section. Although rare, ectopic pregnancy in a scar from a previous cesarean section has increased in parallel with the rise in cesarean section rates. Due to this rarity, case reports are important so that more evidence is investigated in order to systematize the management of the condition.
Aim: To report a case of ectopic pregnancy in healing of a previous cesarean, as well as its management and outcome, with the aim of assisting in the management of new cases. Method: This is a single case report treated at the Gynecology and Obstetrics Service of the São Francisco University Hospital in Providência de Deus – HUSF, located in the city of Bragança Paulista, SP, Brazil. The patient in authorized the use of the data contained in her medical record by signing a Free and Informed Consent Term, and this research was approved by the HUSF Research Ethics Committee.
Conclusion: The description of the patient allowed us to conclude that, due to the large number of problems and risks caused by pregnancy in a scar from a previous cesarean section, including uterine rupture and the death of the pregnant woman, an immediate diagnosis of the condition is necessary, because symptoms such as bleeding are nonspecific for cases of the type. USG is a very helpful diagnostic tool in cases of cesarean scar pregnancy, however, in certain cases, the diagnosis was not confirmed until an MRI was performed. Depending on the lesion and related morbidities, hysterectomy is the only option, as was done in the case reported here, thus avoiding the death of the pregnant woman. However, in cases where the patient still wants to have children, it is possible, albeit with certain risks, to avoid such a procedure, although there is a risk of recurrence.
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