Successful conservative treatment of a caesarean scar twin pregnancy with systemically administered methotrexate and subsequent uterine artery embolization: a rare case report

Caesarean scar pregnancy is a very rare form of ectopic pregnancy. It complicates approximately 1 in 2200 pregnancies. However, it is becoming increasingly more frequent with the increasing number of caesarean sections performed each year. The recommended approach to treatment is therapeutic termination of pregnancy at the time of recognition. In this article, we present a case of caesarean scar pregnancy managed expectantly with Methotrexate and uterine Artery Embolization. We reported a case of 30 years old female, gravida 5, para1, live 1, abortion 3 with a previous history of caesarean section with GA of 8w5d/DCDA twin was admitted in view of low implantation of gestational sacs in lower uterine corpus. Trans vaginal ultrasound done and diagnosis of caesarean scar twin pregnancy was made. She was treated with Methotrexate 50 mg intramuscularly along with uterine artery embolization and follow up with beta HCG levels. Post embolization sac size was reduced and falling level of beta HCG values. Patient was discharged and follow-up with beta HCG level weekly. It is important for obstetrician and radiologist managing women with risk factor for a scar ectopic pregnancy to maintain a high index of suspicion during follow up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive Haemorrhage and maternal death

A rare case report of total uterine rupture from cervix to fundus in an unmarried teenage pregnancy

Uterine rupture is an uncommon and a life threatening obstetric complication. It is mainly a result of delivery by untrained personnel. This is a catastrophic situation where there is a high mortality rate for both the mother and the baby and a nightmare for the obstetrician also. There are many cases of uterine trauma reported in which there may be scar dehiscence, scar rupture, uterine rupture,perforation, cervical injuries, colporrhexis etc.This case report is regarding an unusual and rare presentation of a 19 year old unmarried girl who landed in our institution-a case of total and complete uterine rupture extending from cervix to fundus, a peculiar presentation, a hazardous result of Youtube delivery by her boyfriend highlighted. A scenario where the maternal anatomy totally distorted due to the trauma. This patient managed by immediate resuscitation and uterus reconstructive surgery successfully. In spite of  the advice not to conceive for the next few years, patient turned back to us in the late trimester within the next year itself, again a big challenge. Both the mother and baby managed successfully .With this case report we emphasize the need for immediate intervention in case of suspected uterine rupture and the possibility of successful subsequent pregnancy highlighted