Successful Management Of Massive Haemorrhage In Cervico-Isthmic Pregnancy

Abstract

General physical examination revealed no abnormality. Per speculum examination showed slight fresh bleeding through os. On bimanual examination uterus corresponded to eight weeks size and os was closed. Ultrasound examination showed a fetal node corresponding to nine weeks pregnancy and cardiac activity was absent. The gestation sac was located in the lower part of the endometrial cavity. A diagnosis of missed abortion in the process of expulsion was made and patient taken up for dilatation and suction evacuation. The procedure resulted in massive haemorrhage and shock. Patient was resuscitated with blood transfusion and bleeding controlled with multiple uterotonics. After 30 minutes, patient had fresh episode of profuse bleeding per vaginum. Abdominal examination was not suggestive of haemoperitoneum and local examination revealed a bulky uterus and ballooned cervical canal full of blood clots. In view of her ultrasound picture (Fig.1) and these clinical findings, a diagnosis of cervicoisthmic pregnancy was entertained. Figure 1 Figure 1: Showing gestational sac in cervicoisthmic region U bladder : urinary bladder ,En cavity: endometrial cavity ,G sac: gestation sac