DOI: 10.36347/sjams.2017.v05i10.033

Pages: 3970-3973

The implantation of conceptus within previous caesarean section scar is the rare site of ectopic pregnancy. Early diagnosis and treatment can avoid life threatening complications and save the uterus and future reproductive career of woman. However, a delay in either diagnosis or treatment can lead to uterine rupture, hysterectomy, and significant maternal morbidity. A case of laparoscopic management of an advanced ectopic pregnancy in a previous Caesarean section scar is reported. A 23 year old woman was admitted to our hospital with pelvic supra-pubic pain following six months of caesarean section. Abdominal ultrasound revealed a bulging gestational sac over the lower anterior uterine wall measuring 8.4 X 7.3 X 8.9 cm .Diagnostic laparoscopy revealed bulging lower part of uterus with extreme vascularity and large tortuous vessels on the surface. Hysteroscopy revealed empty uterine cavity. Prophylactic bilateral uterine artery ligation was performed. An incision was made over the most prominent area of the mass by operative laparoscopy. A well formed fetus and placenta was removed from the anterior wall. Some placental bits could not be removed. Laparotomy was performed to secure hemostasis from the incision site and remove the adherent placenta. Two-layer of continuous sutures along the affected uterine wall was made with 1 vicryl. Surgical management enabled the successful treatment of an un-ruptured ectopic pregnancy in a previous Caesarean scar and made it possible to preserve the patient's reproductive capability.