The little-known and dangerous risk of c-section

IT'S the little-known, but dangerous complication of having a caesarean section.

An ectopic pregnancy that implants in the scar tissue of a previous c-section, called a caesarean scar pregnancy or a caesarean scar ectopic pregnancy, is a condition that only a handful of women around the world have experienced.

While still extremely rare, doctors are seeing an increasing number of women presenting with the dangerous pregnancy, possibly linked to an increased level of caesarean births over the past few decades.

Earlier this year, a 38-year-old woman presented to hospital with a history of three previous c-sections. She complained of abdominal pain and vaginal bleeding, her doctors reported in the Oman Medical Journal. She was diagnosed with a CSP.

The doctors, Roy and Radfer, write that CSPs can cause a scar rupture and excessive bleeding and may ultimately require a hysterectomy - the removal of the uterus - to resolve. They endanger the mother's life and impact her future fertility.

After an uncomplicated c-section and then bariatric surgery, Jasmin fell pregnant. At a dating scan at seven weeks, doctors detected a heartbeat, but told her the gestational sac had embedded deeply into her caesarean scar and was pushing against her bladder.

Jasmin underwent a procedure where the site of implantation was injected with a dose of methotrexate to stop the heartbeat. It also required monitoring over six-months to ensure the levels of HCG - the pregnancy hormone - continued to fall . Despite complications, the procedure was initially successful. However, a month and a half into monitoring, Jasmin was rushed to hospital with a massive haemorrhage which required a number of blood and iron transfusions and three days in ICU.

In 2015, doctors presented a case in which a 30-year-old woman presented with a positive pregnancy test in Radiology Case Reports. The woman, a mother-of-two, had previously had both her children by caesarean section.

The team of doctors, lead by Rajarshi Aich, write that CSPs are, "prone for complications like uterine rupture, life-threatening hemorrhage, and hypovolemic shock".

"The true incidence of pregnancy occurring in a uterine scar has not been determined because so few cases have been reported in the literature. However, the incidence of such cases seems to be on the rise. This may reflect both the increasing number of caesarean sections being performed and the more widespread use of the transvaginal scan that allows earlier detection of such pregnancies."

The woman, having already had two children, did not continue the pregnancy and had a hysterectomy.

While, in most instances, these kind of pregnancies do not proceed, the Daily Mail has reported that a woman in the United States, having experienced four CSPs previously chose to proceed with a fifth pregnancy where the amniotic sac had lodged in her caesarean scar.

In fact, the report suggests that a CSP does not always need to be terminated.

This particular case study notes that a CSP increases the risk that the placenta will embed too deeply into the wall of the uterus, a condition known as MAP - morbidly adherent placenta. In a MAP, "placenta tissue becomes too attached to the uterus. Because the two are joined by so many veins, when a woman tried to deliver, she can end up bleeding uncontrollably, endangering her life."

The US woman, who had previously had two healthy children by c-section, continued her pregnancy with careful monitoring by her medical team. She did experience MAP. Eventually the placenta covered the opening to her cervix.

Both the mother and the child survived at early c-section at 34 weeks at the New York University Langone Health Center. However, the mother underwent a hysterectomy following the birth of her baby.

In each of the case studies, doctors emphasise the importance of early detection of a CSP, which allows women more options for treatment, and decreases the risk of maternal infertility and fatality.

Kidspot always recommends you discuss your individual circumstances with your doctor.

This article originally appeared on Kidspot and has been republished here with permission.

Topics:  caesarean childbirth c-section pregnancy risk

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