A Second Trimester Type II Cesarean Scar Pregnancy with Placenta Implantation and Rupture in the Right Wall of the Lower Segment of the Uterus: A Case Report

Jiang L*, Zhang Q, Cao Y, Gan X and Yang F

Department of Obstetrics and Gynecology, Shanghai Jiading Maternity & Infant Health Care Hospital, China

^*Correspondance to: Li Jiang 

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Abstract:

Background: Cesarean Scar Pregnancy (CSP) is the implantation of pregnant tissue in the scar of a prior cesarean. With the progression of pregnancy, the embryo grows deeper and wider around the scar which can cause placenta implantation and even uterine rupture. In early pregnancy, CSP often shows no symptoms or only little vaginal bleeding, and some patients may ignore it. Routine ultrasound examination is most commonly performed for diagnosis of CSP, but when the pregnant tissues with blood clots locate in the whole uterine cavity it is less accurate. Especially in the second trimester, with the growing of pregnant tissue and blood clot occupying nearly the whole uterine cavity inclusive of the lower segment of the uterus, it is difficult for ultrasound or even MRI examination to distinguish it. Case Report: We report a case of a second trimester II type CSP, where the patient, G4P2, had two previous cesareans and two artificial aspiration abortions. The patient presented to our hospital when she was 12+1/7 weeks pregnant with slight vaginal bleeding and occasional mild abdominal pain. Missed abortion was diagnosed because ultrasound examination shows the pregnant sac in the uterine cavity without embryo. Medical abortion was performed. After 3 days, curettage under ultrasound monitoring was performed for incomplete abortion with pregnant tissue residue. During the operation, the ultrasound monitoring revealed CSP with placenta implantation and massive vaginal bleeding occurred. When the uterine contraction drugs failed to stop the bleeding, the laparotomy was performed. Conclusion: CSP is dangerous for patients and difficult to treat especially when the clinician cannot find it in time. Sometime the symptom is not very severe just with little vaginal bleeding and occasional mild abdominal pain. But with the progression of pregnancy especially in II CSP, it will rupture or implant deeply in the uterine muscle even to bladder. So, with many cesareans and curettages, patients must be informed of the danger of pregnancy and receive medical examination and treatment in time. For clinicians we must be vigilant of the CSP for every patient with history of cesarean, we can choice MRI examination when necessary.

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Cite the Article:

Jiang L, Zhang Q, Cao Y, Gan X, Yang F. A Second Trimester Type II Cesarean Scar Pregnancy with Placenta Implantation and Rupture in the Right Wall of the Lower Segment of the Uterus: A Case Report. Ann Clin Case Rep. 2022; 7: 2336..