DOI: 10.36347/sjmcr.2018.v06i06.002

Pages: 372-375

Intramural pregnancy with implantation of Gestational sac fully or partially within a scar caused by previous cesarean section is probably the rarest location for ectopic pregnancy. This type of pregnancy is prone for complications like uterine rupture and life threatening hemorrhage and hypovolemic shock during pregnancy or curettage. True incidence of pregnancy occurring in uterine scar has not been determined because so few cases have been reported in literature. We present a case of 28 yrs. G4P2L2A1 with 6wks amenorrhea presenting to gynecology OPD with PV bleeding and USG suggestive of incomplete abortion with products of conception in cervicoisthamic region. During the procedure of D & C severe bleeding was encounter and procedure was abandoned, tamponade done with Foleys catheter insertion into the uterine cavity. Systemic methotrexate was given to treat it but patient continued to bleed per vaginally and have lower abdominal pain. The amount of bleeding increased over a period of 2 days. Due to ongoing bleeding and in view of complete family hysterectomy was planned. During laparotomy, uterus was of 8-10 weeks size with a soft purplish black mass protruding through the lower uterine segment immediately above the internal os. This mass was intimately apposed and adherent to the bladder wall at the site of C. scar. The mass was of 5 x 4 cm size. Cervix was normal with no growth and the uterine cavity was empty in the fundal region. The finding confirmed the diagnosis of scar pregnancy which was reconfirmed by the HPE report.