RESUMEN
We report two cases of Caesarean scar pregnancies that were managed surgically. The first case was a 33-year-old woman who presented at 21 weeks of gestation with lower abdominal pain. An exploratory laparotomy was performed as she was hypotensive and had a drastic drop in haemoglobin level. Intraoperatively, a ruptured scar ectopic pregnancy with placenta percreta was found. A hysterectomy was performed in view of uncontrolled haemorrhage. The second case was a 30-year-old woman who presented with irregular per vaginal spotting without abdominal pain. Ultrasonography revealed a gestational sac at a previous Caesarean scar, with interval increase in size and development of a yolk sac. On laparoscopy, the diagnosis of scar pregnancy was confirmed, and the gestational sac and surrounding myometrium were excised. Our case report shows that early diagnosis of scar pregnancy is important, as timely intervention can prevent life-threatening complications and preserve fertility.
Asunto(s)
Cesárea/efectos adversos , Cicatriz/fisiopatología , Embarazo Ectópico/diagnóstico , Adulto , Femenino , Humanos , Laparotomía/métodos , Miometrio/cirugía , Placenta Accreta/diagnóstico , Placenta Previa/diagnóstico , Embarazo , Embarazo Ectópico/etiología , Resultado del Tratamiento , Rotura Uterina/diagnósticoRESUMEN
We describe the successful use of a balloon catheter in primary postpartum haemorrhage secondary to placenta praevia. A 29-year-old woman was admitted for cervical priming at 37 weeks. Antenatal screening ultrasonography showed a normally-sited placenta. During the surgical induction of labour, bleeding per vaginum was noted, and a mass was felt at the cervical os. Emergency caesarean section was performed, and a placenta praevia was confirmed. Upon reversal of general anaesthesia, vaginal bleeding was noted despite a well-contracted uterus. The estimated blood loss was 1,200 ml. A hydrostatic catheter was inserted vaginally into the uterine cavity. After 17 hours, it was removed with no vaginal bleeding. The insertion for the balloon catheter was easy and simple, requiring minimal analgesia, and it was without significant complication. As obstetricians become more confident in this technique, surgical intervention may be avoided. This may subsequently lead to a reduction in maternal morbidity and mortality.