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Case Report
Conservative surgical management of a heterotopic scar pregnancy: A case report
1 MS (Ob/Gy), DRCOG, Dip Gyn Endoscopy, Consultant Gynecologist, Poona Hospital & Research Center, Pune, India
2 MBBS, DMRD, Intervention Radiologist, Poona Hospital & Research Center, Pune, India
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Neela Desai
MS (Ob/Gy), DRCOG, Dip Gyn Endoscopy, Consultant Gynecologist, Poona Hospital & Research Center, Pune 411004,
India
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Article ID: 100154Z08ND2023
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Desai N, Mutatkar M. Conservative surgical management of a heterotopic scar pregnancy: A case report. J Case Rep Images Obstet Gynecol 2023;9(2):1–6.ABSTRACT
Introduction: The cesarean scar pregnancy is on rise and the objective of this case study is to highlight a different, bold but conservative approach to an unusual challenging case of eight weeks heterotopic cesarean scar pregnancy, which was threatening to rupture.
Case Report: A 31-year-old G3P2L1 previous two cesarean sections presented with lower abdominal pain and bleeding. She was hemodynamically stable, and ultrasonography (USG) and magnetic resonance imaging (MRI) revealed heterotopic pregnancy, eight weeks (gestational sacs > 32 mm) intrauterine and caesarean scar pregnancy, which was threatening to rupture. Since the scar pregnancy was large, BHcG was > 200,000 iu, there was evidence of imminent scar dehiscence; and she was stable and had good blood parameters. The authors decided to take cautious but bold decision of suction evacuation under USG guidance, following the uterine artery embolism. The procedure was smooth and lower segment scar sacculus bleeding was controlled by compression with help of Foley’s balloons inside uterine cavity as well as in bladder. There was no evidence of extrauterine bleeding. She made a good post-operative recovery. Follow-ups consisted of serial BHcG and USG to monitor the regress.
Conclusion: This case study implies that cesarean scar pregnancy, even with imminent scar dehiscence can be managed by USG-guided suction evacuation by experienced hands. Prior uterine artery embolization (UAE) added the safety of bleeding control. This case also emphasizes the importance of a patient monitoring and relying on failing BHcG, and a symptom free patient; and not on mass in CS scar alone which was slow to resolve.
Keywords: Foley’s catheter tamponade, Heterotopic scar pregnancy, Suction evacuation, Uterine artery embolism
SUPPORTING INFORMATION
Author Contributions
Neela Desai - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mukul Mutatkar - Substantial contributions to conception and design, Acquisition of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Neela Desai et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
