Case Report: Cesarean Scar Pregnancy in 8 Weeks Pregnancy with History of Recurrent Pregnancy Loss
Abstract
Introduction: Caesarean scar pregnancy is a complication in early pregnancy implants gestational sac in the myometrium and fibrous tissues at the site of a previous uterine scar. Recurrent pregnancy loss defines loss as two or more pregnancies that do not have to be consecutive. This condition presents a substantial risk for severe maternal morbidity and associated with psychological aspects.
Case Illustration: Mrs. D 37 years old, G6P2A3 in her 8 weeks pregnancy. With significant lower abdominal pain and vaginal bleeding occurs for two days in the beginning of pregnancy. Blood pressure of 70/50mmHg, pulse rate of 100x/min, respiration rate of 22x/min, temperature of 36,6°C, SpO2 of 100%, hemoglobin of 10,7 gr/dL. Abdominal examination was significant for rebound tenderness on lower abdomen. Transvaginal ultrasound which showed a fetus in uterine cavity and a moderate amount of free fluid in intraperitoneal cavity. Upon surgery, 1000cc of blood was found pooled in the peritoneal cavity, and laceration with length of 2 cm, about 5 cm below the uterine fundus.
Conclusions: Caesarian scar pregnancy incident is increasing, as a result of high caesarian delivery rate, so the clinician should always ask for the past obstetrical history, particularly in patient with recurrent pregnancy loss with curettage procedure.
Laporan Kasus:
Kehamilan Bekas Luka Sesar pada Kehamilan 8 Minggu dengan Riwayat Keguguran Berulang
Abstrak
Pendahuluan: Kehamilan bekas luka caesar adalah komplikasi pada awal kehamilan yang menanamkan kantung kehamilan di miometrium dan jaringan fibrosa di lokasi bekas luka rahim sebelumnya. Keguguran berulang diartikan sebagai keguguran sebagai dua atau lebih kehamilan yang tidak harus terjadi secara berurutan. Kondisi ini menimbulkan risiko besar terhadap morbiditas ibu yang parah dan berhubungan dengan aspek psikologis.
Ilustrasi Kasus: Ny. D 37 tahun, G6P2A3 dalam usia kehamilan 8 minggu, dengan nyeri perut bagian bawah yang signifikan dan perdarahan vagina terjadi selama dua hari di awal kehamilan. Tekanan darah 70/50mmHg, denyut nadi 100x/menit, laju pernapasan 22x/menit, suhu 36,6°C, SpO2 100%, hemoglobin 10,7 gr/dL. Pemeriksaan perut nyeri tekan signifikan pada perut bagian bawah. USG transvaginal menunjukkan janin dalam rongga rahim dan sejumlah cairan bebas dalam rongga intraperitoneal. Setelah operasi, ditemukan 1000cc darah menggenang di rongga peritoneum, dan terjadi laserasi sepanjang 2cm, sekira 5cm di bawah fundus uteri.
Kesimpulan: Kejadian kehamilan bekas luka caesar semakin meningkat akibat tingginya angka kelahiran caesar sehingga dokter harus selalu menanyakan riwayat obstetri masa lalu, terutama pada pasien dengan keguguran berulang dengan tindakan kuretase.
Kata kunci: kehamilan bekas luka sesar, keguguran berulang
Keywords
Full Text:
PDFReferences
Russell Miller 1, Ilan E Timor-Tritsch 1, Cynthia Gyamfi-Bannerman 1 Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy. (cited 29 Februari 2024). Available from : https://pubmed.ncbi.nlm.nih.gov/31972162/
Shraddha A Mevada , Madhuri A Mehendale, Ruptured Scar Ectopic Pregnancy: A Near Miss Case, Journal of South Asian Federation of Obstetrics and Gynaecology (2020): 10.5005/jp-journals-10006-1766. (cited 29 Februari 2024). Available from : https://www.researchgate.net/profile/Madhuri_Mehendale/publication/345499035_Ruptured_Scar_Ectopic_Pregnancy_A_Near_Miss_Case/links/61e55cb29a753545e2d97415/Ruptured-Scar-Ectopic-Pregnancy-A-Near-Miss-Case.pdf
Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006;107(6):1373–1381. DOI: 10.1097/01.AOG.0000218690.24494.ce.
Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol 2008;35(3): 519–529. DOI: 10.1016/j.clp.2008.07.003.
Dimitriadis, E., Menkhorst, E., Saito, S. et al. Recurrent pregnancy loss. Nat Rev Dis Primers 6, 98 (2020). (cited 29 Februari 2024). Available from: https://doi.org/10.1038/s41572-020-00228-z
Tomkiewicz, Julia, and Dorota Darmochwał-Kolarz. 2023. "The Diagnostics and Treatment of Recurrent Pregnancy Loss" Journal of Clinical Medicine 12, no. 14: 4768. (cited 29 Februari 2024). Available from: https://doi.org/10.3390/jcm12144768 . https://www.mdpi.com/2077-0383/12/14/4768
The ESHRE Guideline Group on RPL; Atik, R.B.; Christiansen, O.B.; Elson, J.; Kolte, A.M.; Lewis, S.; Middeldorp, S.; Mcheik, S.; Peramo, B.; Quenby, S.; et al. ESHRE guideline: Recurrent pregnancy loss: An update in 2022.
Cunningham F, & Leveno K.J., & Dashe J.S., & Hoffman B.L., & Spong C.Y., & Casey B.M.(Eds.), [publicationyear2] Williams Obstetrics, 26e. McGraw Hill. P597-600
Ban, Yanli MD, PhD; Shen, Jia MD; Wang, Xia MD; Zhang, Teng MD, PhD; Lu, Xuxu MD; Qu, Wenjie MD; Hao, Yiping MD; Mao, Zhonghao MD; Li, Shizhen MD; Tao, Guowei MD, PhD; Wang, Fang MD, PhD; Zhao, Ying MD, PhD; Zhang, Xiaolei MD, PhD; Zhang, Yuan MD, PhD; Zhang, Guiyu MD, PhD; Cui, Baoxia MD, PhD. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstetrics & Gynecology 141(5):p 927-936, May 2023. (cited 27 februari 2024). Available from: https://journals.lww.com/greenjournal/fulltext/2023/05000/cesarean_scar_ectopic_pregnancy_clinical.10.aspx#JCL-P-9
Shah P, Manandhar R, Thapa M, Saha R. Ruptured Cesarean Scar Pregnancy: A Case Report. JNMA J Nepal Med Assoc. 2019 May-Jun;57(217):209-212. doi: 10.31729/jnma.4465. PMID: 31477966; PMCID: PMC8827501 (cited 27 februari 2024). Available from: https://pubmed.ncbi.nlm.nih.gov/31477966/
Ipsita Mohapatra , Subha R. Samantray 1. Obstetrics and Gynecology, All India Institute of Medical Sciences Kalyani, Kalyani, IND. Scar Ectopic Pregnancy - An Emerging Challenge. (cited 29 Februari 2024). Available from: https://assets.cureus.com/uploads/original_article/pdf/65077/20210826-21208-jfvp32.pdf
Gupta P, Huria A, Kaur D, Mehra R. Caesarian Scar Pregnancy- a Diagnostic Dilemma. JNMA J Nepal Med Assoc. 2016 Apr-Jun;54(202):88-90. PMID: 27935931. (cited 29 Februari 2024). Available from: https://pubmed.ncbi.nlm.nih.gov/27935931/
Paul Pirtea, Ettore Cicinelli, Rosalba De Nola, Dominique de Ziegler, Jean Marc Ayoubi, Endometrial causes of recurrent pregnancy losses: endometriosis, adenomyosis, and chronic endometritis,Fertility and Sterility,Volume 115, Issue 3,2021,Pages 546-560,ISSN 0015-0282,https://doi.org/10.1016/j.fertnstert.2020.12.010. (https://www.sciencedirect.com/science/article/pii/S0015028220327527)
XianYi Zhou, Hua Li, XiaoDong Fu, Identifying possible risk factors for cesarean scar pregnancy based on a retrospective study of 291 cases. 2020 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/jog.14163
DOI: http://dx.doi.org/10.24198/obgynia.v7i3.688
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.