Abstract

ISTHMIC PREGNANCY ON THE UTERINE SCAR ABOUT A CASE AND REVIEW OF THE LITERATURE

M. Ould Dadda*, A. Hassine, Sid. Elmustaph, A. Benbella, R. Bezad, A. Filali, Z. Tazi, M. H. Alami

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Abstract

Pregnancy in the cesarean section scar is a rare form of ectopic pregnancy, which can be life-threatening due to the high risk of massive bleeding by uterine rupture. The pathophysiological mechanism is still poorly understood. The clinical signs (abdominal pain, metrorrhagia) are non-specific. In a third of cases, the diagnosis will be made in an asymptomatic woman. The diagnosis is based on ultrasound criteria: empty uterine cavity and cervical canal, presence of a gestational sac in the myometrium at the antero-isthmic level with absence of myometrial tissue or reduction in the thickness of the myometrium between the gestational sac and the bladder. In case of diagnostic doubt, we can use three-dimensional ultrasound and magnetic resonance imaging (MRI). Indeed, it can be confused with a miscarriage during evacuation located at the isthmic or cervical level, a cervical pregnancy or a trophoblastic tumor. Several therapeutic options are possible if the pregnancy is not prolonged: medical treatment with methotrexate, simple evacuating curettage or curettage after ligation or embolization of the uterine arteries, and hysterectomy. The success of conservative treatment seems to be able to be correlated with the criteria used in cervical pregnancies, taking into account cardiac activity, βHCG levels, gestational age and craniocaudal length. We report the case of an isthmic pregnancy on the hysterotomy scar while highlighting the diagnostic traps to avoid.

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