Author/Authors :
Mortazavi Forough نويسنده Education Development Center, Sabzevar University of Medical Sciences, Sabzevar, IR Iran , Eftekhariyazdi Mitra نويسنده Department of Obstetrics and Gynecology, Faculty of
Medicine, Sabzevar University of Medical Sciences, Sabzevar, IR
Iran , Yousefi Moghaddam Manijeh نويسنده MD, Anesthesiologist, Assistant Professor, Department of
Anesthesiology, School of Medicine, Sabzevar University of Medical
Sciences, Sabzevar, Iran , Souizi Behnaz نويسنده MD, Gynecologist, Assistant Professor, Department of
Obstetrics and Gynecology, School of Medicine, Sabzevar University
of Medical Sciences, Sabzevar, Iran
Abstract :
Introduction Cesarean rate increased in recent decades worldwide.
One of the consequences of the increased cesarean rate and repeat
cesarean is the significant increase in cesarean scar pregnancies
(CSPs). Diagnosis of a CSP is more difficult when there is a heterotopic
pregnancy in a non-assisted pregnancy. Case Presentation The patient was
a 34-year-old G5P2L2Ab2 referred for spotting in Shahidan Mobini
hospital, Sabzevar, Iran in 2016. She had a history of 2 cesareans and 2
abortions. Three ultrasounds were performed showing a gestational sac in
the lower segment of the uterus with different diagnoses: 1) with
hemorrhage over it, 2) with the 2nd gestational sac over it, which was
diagnosed as missed abortion, and 3) with an echo-free and irregularly
region supporting the 2nd sac or a clot in the lower part of the uterus.
The increased local vascularity suggested a level of placenta accreta,
partial mole, or trophoblastic reaction. Since the first diagnosis was
missed abortion, curettage was performed. Due to the continuation of
severe bleeding, abdominal hysterectomy was performed. The patient was
discharged in good condition after 3 days. Conclusions Heterotopic CSP
does not have any specific symptoms, which caused it to be easily
misdiagnosed. Physicians should use precise diagnostic tests in case of
controversial test results.
