Ruptured Cervicoisthmic Pregnancy with 20 Weeks Intrauterine Foetal Death Lying in Left Broad Ligament- A Case Report

Abstract

Abnormal Low Lying Implantation of Ectopic Pregnancy (LLIEP) may occur in cervix, cervico isthmic region or caesarean scar. Cervicoisthmic pregnancy remains the rarest form of LLIEP, a life threatening cause of maternal morbidity and mortality with an incidence of 1 in every 2400 to 4500 pregnancies. In isthmic implantation, the gestational sac is located more cranially and between the cervix distally and the decidualised functional endometrium cranially. Transvaginal Ultrasound (TVS), Colour Doppler and Magnetic Resonance Imaging (MRI) remain gold standard modalities for early diagnosis. Ultrasonography depicts bulging lower uterine segment with a normal cervical length and consistency. Here, the author reports a rare case of ruptured isthmic pregnancy with 20 weeks intrauterine foetus death lying in left broad ligament in a 33-year-old unbooked G3P2L2 with gestation of 31 weeks presenting in emergency. Ultrasonography depicted intrauterine foetus death with foetus lying in lower segment of uterus. Lower section caesarean section for failed induction confirmed hour glass uterus with empty upper uterine segment and bulging, distended, couvelaire lower uterine segment and left lateral rupture at cervicoisthmic junction. Dead 20 weeks foetus lying in leaves of left broad ligament. Peripartum hysterectomy was done as a life saving procedure. Cervicoisthmic pregnancy is rarest form of LLIEP and diagnosis may result in rupture with need of peripartum hysterectomy.