Another risk of cesarean surgery

A 26-yr old woman was 8-weeks pregnant and experiencing some light bleeding. Her previous birth was by cesarean section. When an ultrasound was done to see the cause of her bleeding the technician could find no baby in her womb. Instead, the baby was developing in the separating edges of her cesarean scar!

I wonder what the conversation was like that lead to her agreement to have a hysterectomy and loose both her baby and her uterus. The medical notes were shared on Medscape Today, an excellent medical educational site by WebMD.

It is beyond sad that medical notes are written without reflecting the emotional journey of the patient. Here is an excerpt of the notes.

• Sonographic evaluation revealed an empty uterine cavity and endocervical canal, but a gestational sac was seen in the myometrium anteriorly and at the level of the uterine isthmus. The gestational sac bulged anteriorly and was separated from the bladder by only a 7-mm layer of myometrium.
• Our patient desired no future fertility and hysterectomy was selected to treat her cesarean delivery scar pregnancy (CDSP). Intraoperatively, a bulge at the level of the isthmus was noted anteriorly. The bladder was dissected from the lower anterior uterus, and the CDSP was seen distinctly. Hysterectomy was completed without complication. The patient’s recovery was uneventful.

It sounds like the young mother was game for the hysterectomy. But the truth behind the statement is that she simply agreed to the surgery. What could she do? What options could she be offered? To continue the pregnancy and see if by some miracle she and the baby survived? The sac wasn’t in the tube. But it seems unlikely the baby could go to term. Few women would have continued this pregnancy.

Still, I can’t believe her thoughts when she woke the next day was that getting over this was “uneventful.”

My thoughts are with her. And with our nation and world as the rising cesarean tide claims more and more lives, wombs, and hopes, as well as cumulative years of well being from the women of the world.