City hospital saves a young mother from the rarest scar pregnancy
The recent case of caesarean scar pregnancy with Itoshri Gangopadhyay from Kharagpur, a young mother who was expecting her second child is an eye opener towards this rarest disease which happens in 1 out of 4000 or 5000. The mother was counting days waiting for her second child to be born. However, she failed to understand that like a normal case of pregnancy the foetus was just not growing inside the womb. The growth was taking place around the scar on the lower part of the uterus which is a result of caesarean delivery of the first child. When this fatal disorder was detected, by that time profuse internal bleeding in the uterus has already begun. Even under a life endangered situation, Kolkata’s CK Birla Hospitals has been able to combat the peril and save her life. An immature foetus was removed from the uterus so as to save Itoshri’s life who became victim to the rarest caesarean scar pregnancy.
Itoshri, a 31 year old mother to a 6 year child had conceived for the second time. The initial term of the pregnancy was fine. The gynaecologist had ignored the frequent primary bleeding symptom. Unexpectedly, the problem blew out of proportion on the 11th week. In middle of April, suddenly unbearable pain started on the lower part of the abdomen followed by excessive bleeding. Rudrapratim Gangopadhyay, her husband who is an employee of a private organization says that doctor immediately on checking warned us against such grave symptoms. Through Trans Vaginal Scan (TVS) post ultrasonography an abnormal pregnancy called caesarean scar pregnancy, also known as ectopic pregnancy was detected.
Dr. S M Rahman, Consultant obstetrics gynaecologist at CKBH – CMRI defines that caesarean scar pregnancy is one kind of ectopic or abnormal pregnancy which generally happens when a woman has a background of 3-4 caesarean cases and thereby a scar is formed around the wall of the uterus. Generally under caesarean cases when a uterus is cut and joined back, a scar is formed on the lower part of the uterus and with an implantation of pregnancy around that scar, it is called caesarean scar pregnancy. By implantation it is referred to the establishment of pregnancy. Any pregnancy occurs primarily in the fallopian tube and then gets established on the upper part of the uterus wherein in case of caesarean scar pregnancy it gets established on the lower part where the scar exists.
The gravest consequence of this disorder is excessive bleeding which is so catastrophe in nature that it may lead to death. Such blood loss at a relatively lower degree of consequence can also lead to anaemia. Besides, specialists are also of the opinion that untimely removal of the foetus also inevitably leads to death.
The prompt and diligent measures undertaken by the doctors at CKBH – CMRI have contributed to successfully avoiding any grave consequence for Itoshri from our neighbour town. On examining the reports, the family members were right away advised to bring her to Kolkata. When the family reached Kolkata on 24th April, on that very night itself operation was conducted post certain tests. Dr. Rahman and his expert team of doctors within few hours of endeavour have reduced the bleeding and removed the foetus from the scar in the uterus. The doctors have been further successful to restore Itoshri’s uterus.
Dr. Rahman says, “For the first time in Kolkata, we got a case of ectopic scar pregnancy. Itoshri was suffering from bleeding for 6 consecutive days. Internal bleeding had occurred too, which could not be washed employing the conventional methods. Laparoscopy results also detected that there has been bloodshed inside the stomach. If the stomach is dissected then tremendous bleeding can cause shock to a patient. Under such scenario the patient’s normalcy cannot be revived.”
There are two kinds of prognosis under this disorder. One is that the pregnancy can grow for 7-8 months or for the entire term around the scar and this is very dangerous since it develops a morbid adherent placenta which cannot be separated from the uterus post-delivery. Additionally such patients in the operation theatre during delivery start bleeding so profusely that uterus needs to be removed so as to save the patient. The second prognosis is that the pregnancy does not grow at all, however, there would be continuous bleeding.
Symptoms for precaution
- Caesarean delivery of first child
- Frequent bleeding from beginning
- Pain in lower abdomen followed by excessive bleeding
Advices from gynaecologists to radiologists
- During ultrasound even the slightest on outer and inner part of womb should not be avoided
- Trans vaginal scan is recommended if a doubt arises
- Ectopic pregnancy to be considered during ultrasound