Twenty-eight years, gravida-3 para-2 with two and half
month’s amenorrhea with previous two LSCS with USG
report (Figs. 1, 2, and 3) showing 11 weeks single intrauterine
pregnancy presented for MTP.
MTP was started under GA. As soon as dilator was introduced,
profuse bleeding started. Quickly evacuation was
attempted, and POCs were evacuated as much as possible.
Though, the bleeding had reduced, there was persistent and
significant trickle. Uterine massage was given along with
oxytocin drip and intramuscular carboprost. The patient
still had blood trickling out, and USG showed collection
of clots in lower part of uterus. Thinking it could be due
to incomplete evacuation, another attempt at curettage
resulted in torrential bleeding again, and bleeding reduced
after curette was removed. Uterine packing was done with condom catheter but bleeding persisted. Hence, decision for
laparotomy with SOS hysterectomy was taken. On opening
abdomen, uterus was almost normal size with lower segment
ballooned suggestive of scar pregnancy (Figs. 4 and 5). Total
hysterectomy (Fig. 6) was done, and the patient was given
three packed cells transfusion. Postoperative recovery was
uneventful.
On retrospective evaluation of USG reports, pregnancy was seen in the lower uterine segment with thinning of myometrium. Hence, it is important to keep in mind possibility of scar ectopic in cases of previous LSCS even when USG report is given as intrauterine pregnancy.
