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Caesarean Section Scar Ectopic Pregnancy
IMAGE OF THE MONTH
Caesarean Section Scar Ectopic Pregnancy Robin Thurman, MBBS, MRANZCOG, Wendy Whittle, MD, PhD, FRCSC, Ally Murji, MD, MPH, FRCSC Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON
A
34-year-old woman with a history of two previous Caesarean sections underwent a dating ultrasound at eight weeks’ gestation in her third pregnancy. This identified a Caesarean section scar ectopic pregnancy. She received four doses of intramuscular methotrexate over eight days, using a multi-dose inpatient regimen. Serum β-hCG levels reduced from 91 000 IU/L to 15 000 IU/L over four weeks but subsequently plateaued. Repeat ultrasound assessment revealed a collapsed uterine fundus and a live 13-week size fetus distending the Caesarean section scar (Figure 1). The patient declined to undergo hysterectomy. Feticide was performed using
Figure 1.
ultrasound-guided intra-cardiac injection of KCl. Fortyeight hours later, the patient underwent laparoscopy; the pelvic findings are shown in Figure 2. Both internal iliac arteries were clipped and the pregnancy was evacuated transcervically under laparoscopic and ultrasound guidance. A Foley catheter was used for hemostasis in the lower uterine segment. Consent to publish these images was obtained from the patient.
J Obstet Gynaecol Can 2015;37(9):767
Figure 2.
PREGNANCY
FUNDUS
SEPTEMBER JOGC SEPTEMBRE 2015 l 767
Caesarean Section Scar Ectopic Pregnancy Robin Thurman, MBBS, MRANZCOG, Wendy Whittle, MD, PhD, FRCSC, Ally Murji, MD, MPH, FRCSC Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON
A
34-year-old woman with a history of two previous Caesarean sections underwent a dating ultrasound at eight weeks’ gestation in her third pregnancy. This identified a Caesarean section scar ectopic pregnancy. She received four doses of intramuscular methotrexate over eight days, using a multi-dose inpatient regimen. Serum β-hCG levels reduced from 91 000 IU/L to 15 000 IU/L over four weeks but subsequently plateaued. Repeat ultrasound assessment revealed a collapsed uterine fundus and a live 13-week size fetus distending the Caesarean section scar (Figure 1). The patient declined to undergo hysterectomy. Feticide was performed using
Figure 1.
ultrasound-guided intra-cardiac injection of KCl. Fortyeight hours later, the patient underwent laparoscopy; the pelvic findings are shown in Figure 2. Both internal iliac arteries were clipped and the pregnancy was evacuated transcervically under laparoscopic and ultrasound guidance. A Foley catheter was used for hemostasis in the lower uterine segment. Consent to publish these images was obtained from the patient.
J Obstet Gynaecol Can 2015;37(9):767
Figure 2.
PREGNANCY
FUNDUS
SEPTEMBER JOGC SEPTEMBRE 2015 l 767