EC Gynaecology

An ectopic pregnancy is a pregnancy in which the developing blastocyst becomes implanted at a site other than the endometrium of uterine cavity. Most common extrauterine locations are the fallopian tube, however, incidence of implantation to other sites are rising and likely related to assistant fertility treatment and previous scar of uterus. Unfortunately, despite improvement in diagnosis, hemorrhage in first trimester of pregnancy is still a leading cause of maternal death.

Cesarean scar pregnancy is a rare, life threatening form of ectopic pregnancy where gestation sac partially or fully implanted to previous scar. If it progresses to second or third trimester, there would be an increased risk of uterine rupture, catastrophic bleeding and maternal death. Ovarian ectopic pregnancy also a rare event and not uncommon to be confused with hemorrhagic cyst or corpus luteal cyst during clinical evaluation and operation.

Emergency life threatening presentation of ectopic pregnancies are not uncommon, clinical judgement along with basic ultrasound skills can save the life of a woman. Despite working in high resource countries with all required facilities, emergency rare cases are still challenging. High risk behaviors, Immigrant status, insufficient health care access and unawareness of health care are a basic factor to expect increase in such presentation. Moreover, increased rate of caesarean section is a major risk factor for placental spectrum disease or scar pregnancy or scar niche.

We thereby, present a two interesting case reports of similar presentation of ovarian and scar pregnancy which, however share the same nature of disease but entirely different in location and etiology. Both presented in state of hemodynamic shock without proper early pregnancy assessment, both successfully managed by surgery and discharged in stable condition with appropriate follow up plan.

Keywords: Cesarean Scar; Ovarian Ectopic Pregnancy; Massive Hemoperitoneum

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