Summary:
Caesarean section rate is increasing day by day. Incidence of
caesarean scar pregnancy (CSP) is also increasing. Prompt
and multidisciplinary approach towards diagnosis of the
condition is required to reduce associated morbidity. Major
haemorrhage and hysterectomy are the main risks associated
with CSP. Therefore, adequate counseling and availability
of surgical expertise and blood transfusion should be part of
a comprehensive management strategy. There are many single
reports in literature but only few case series. In this paper, 10
cases of caesarean scar pregnancy treated in Obstetrics and
Gynaecology department of CMH Dhaka, CMH Jashore
and Hightech Multicare Hospital Private Limited over 10
years are analyzed. Three of 10 patients had mild pain in
their lower abdomen and vaginal bleeding. Seven of them
had profuse bleeding during D&C for miscarriage as they
were not diagnosed at the time of admission. All patients
had 1 or 2 caesarean sections. Gestational age of the
pregnancy was estimated from 8 to 12 weeks by the last
menstrual period. 9 patients were treated surgically. Eight of
them had local resection of ectopic pregnancy mass with
conservation of the uterus. One patient was treated with D&C
followed by intrauterine balloon catheter insertion to control
excessive bleeding. There was no total or subtotal
hysterectomy. One patient was treated with Inj. Methotrexate.
Common symptoms of caesarean scar pregnancy are pain in
the lower abdomen and variable degree of vaginal bleeding.
The treatment depends on severity of symptoms, gestational
age and experience of the obstetrician dealing these cases.
Keywords: Caesarean section, Scar ectopic pregnancy,
Maternal morbidity.
(J Bangladesh Coll Phys Surg 2019; 37: 191-195)
DOI: http://dx.doi.org/10.3329/jbcps.v37i4.43349