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Department of Radiology
Seth G.S. Medical College and K.E.M. Hospital, Mumbai , India
Case of the Day
Case of the Day
A 33 year old pregnant woman, G4P3 came at a gestational age of 28 weeks with abdominal pain, bleeding per vaginum and decreased perception of fetal movements since six hours. On examination there was scar tenderness, maternal tachycardia and loss of uterine contour. The patient had bad obstetric history with two previous lower-segment Cesarean sections and one vertical incision Cesarean section- all resulting in stillbirths.
A 33 year old pregnant woman, G4P3 came at a gestational age of 28 weeks with abdominal pain, bleeding per vaginum and decreased perception of fetal movements since six hours. On examination there was scar tenderness, maternal tachycardia and loss of uterine contour. The patient had bad obstetric history with two previous lower-segment Cesarean sections and one vertical incision Cesarean section- all resulting in stillbirths.
On ultrasonography, a single, partly intrauterine gestation was seen. Fetal cardiac activity was seen. There was as rent anterior uterine wall measuring approximately 5.5cm x 4.5cm. The placental tissue and the fetal torso and limbs were seen protruding outside the endometrial cavity through the rent into the left iliac fossa and lumbar region. Only the head of the fetus was in the lower segment of the gravid uterus. The femoral length was 50.9mm corresponding to a gestational age of 27 weeks 0 days. There was moderate ascites with echoes extending upto the Morrison’s pouch. Emergency laparotomy was performed; the intraoperative findings were consistent with the ultrasonographic findings.
On ultrasonography, a single, partly intrauterine gestation was seen. Fetal cardiac activity was seen. There was as rent anterior uterine wall measuring approximately 5.5cm x 4.5cm. The placental tissue and the fetal torso and limbs were seen protruding outside the endometrial cavity through the rent into the left iliac fossa and lumbar region. Only the head of the fetus was in the lower segment of the gravid uterus. The femoral length was 50.9mm corresponding to a gestational age of 27 weeks 0 days. There was moderate ascites with echoes extending upto the Morrison’s pouch. Emergency laparotomy was performed; the intraoperative findings were consistent with the ultrasonographic findings.
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