Nwankwo Malarchy E, Egeonu Richard O, Ikeotuonye Arinze C, Eleje George U, Okafor Chisolum O, Ikpeze Golibe C, Ugadu Samuel N, Agbanu Chimezie M, Nwankwo Adamalarchy F, Okafor Chigozie G
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Awka, Anambra State, Nigeria.
SAGE Open Med Case Rep. 2024 Sep 25;12:2050313X241286670. doi: 10.1177/2050313X241286670. eCollection 2024.
Caesarean scar pregnancy is a rare type of ectopic pregnancy with the potential for catastrophic outcomes. A high index of suspicion is required for prompt diagnosis and intervention to improve outcomes. This report describes a rare case of Caesarean scar pregnancy, which was initially misdiagnosed as a threatened miscarriage and cervical ectopic pregnancy. A 35-year-old multiparous lady with two previous caesarean sections presented to the Gynaecology Unit of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nigeria, at an estimated gestational age of 10 weeks, with recurrent vaginal bleeding of eight weeks' duration. She was referred to our facility from a private hospital, where she had first been managed as a case of threatened miscarriage and later as a cervical ectopic pregnancy. The transvaginal ultrasound in our facility was in keeping with a viable Caesarean scar pregnancy. The urine pregnancy test was positive, and the quantitative serum beta human chorionic gonadotropin was 75.6 mIU/ml. She had initial medical treatment with a combination of systemic multidose and intrauterine sac methotrexate and, subsequently, hysterotomy. Following systemic and local methotrexate, there was the demise of the foetus, which was evacuated at hysterotomy, and the uterine scar defect was repaired. She was discharged home in stable clinical condition one week after surgery. Her serum beta human chorionic gonadotropin dropped to 51.6 mIU/mL two weeks post-hysterotomy, and her urine pregnancy test became negative three weeks later. Though rare, caesarean scar pregnancy should be considered a differential diagnosis in reproductive-aged women with a previous caesarean section who present with vaginal bleeding in the first trimester.
剖宫产瘢痕妊娠是一种罕见的异位妊娠类型，具有导致灾难性后果的可能性。需要高度怀疑指数以进行及时诊断和干预，从而改善结局。本报告描述了一例罕见的剖宫产瘢痕妊娠病例，该病例最初被误诊为先兆流产和宫颈异位妊娠。一名35岁有两次剖宫产史的经产妇，在估计孕龄10周时，因持续8周的反复阴道出血，就诊于尼日利亚纳姆迪·阿齐克韦大学教学医院（NAUTH）妇科。她从一家私立医院转诊至我们的机构，在那家私立医院她最初被当作先兆流产病例处理，后来又被诊断为宫颈异位妊娠。我们机构的经阴道超声检查结果符合活胎剖宫产瘢痕妊娠。尿妊娠试验呈阳性，血清β-人绒毛膜促性腺激素定量为75.6 mIU/ml。她最初接受了全身多剂量联合宫腔内孕囊甲氨蝶呤的药物治疗，随后进行了子宫切开术。在全身和局部应用甲氨蝶呤后，胎儿死亡，在子宫切开术中被清除，子宫瘢痕缺损得以修复。术后一周，她临床状况稳定出院。子宫切开术后两周，她的血清β-人绒毛膜促性腺激素降至51.6 mIU/mL，三周后尿妊娠试验转为阴性。尽管罕见，但对于有剖宫产史且在孕早期出现阴道出血的育龄妇女，应将剖宫产瘢痕妊娠视为鉴别诊断之一。
