Caesarean Scar Pregnancy: A Maternal Near- Miss In The Sandema District Hospital, Ghana

Abstract

Introduction: An ectopic pregnancy located in a caesarean scar could have more catastrophic sequelae due to abnormal placentation and early invasion of the myometrium. It has a high possibility of Placenta previa and antenatal uterine rupture as the pregnancy
progresses with gestational age. It is very high risk for severe maternal morbidity and associated high maternal mortality.
The case: We presented a case reporting a few weeks after missing her period to the Sandema District Hospital with bleeding per vaginum and a positive urine pregnancy test. The initial diagnosis was a threatened miscarriage with a differential of possible
cervicoisthmic pregnancy after ultrasound scan was done. She was managed conservatively as a case of threatened miscarriage to be reviewed weekly but she defaulted to review and presented four months later with hemodynamic instability after she collapsed at home at 18 weeks gestation. Laparotomy with wedge resection and reconstruction of the previous caesarean section scar was done on account of ruptured uterus and placenta percreta at 18 weeks.
Conclusion: In patients with previous caesarean scar, caesarean ectopic pregnancy should also be suspected when managing them for threatened abortions even in primary care facilities of low income countries.