Isthmocele of lateral wall of uterus encountered at Suction evacuation- A maternal near-miss

Abstract

A 29-year-old young third gravida with history of previous 2 caesarean sections who was referred as partial mole at 9 weeks of pregnancy was evaluated and diagnosed to have missed abortion. Clinically her general condition was good, uterus was 14 weeks size and she underwent suction evacuation. Torrential haemorrhage occurred after removal of some products of conception and a bag like structure was felt in the lower pole of uterus on passage of curette. Onsite USG evaluation suspected scar pregnancy and she underwent immediate laparotomy and bilateral internal iliac artery ligation because of haemorrhagic shock. At laparotomy left lateral wall mass of size 2x3 cm was found which was communicating to the uterus suggestive of Isthmocele. Excision and repair was carried out and she recovered well due to timely blood transfusion. This finding of isthmocele was missed on routine ultrasound evaluation prior to management plan mainly because of its location.