Cargando…
Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana
Patient: Female, 35-year-old Final Diagnosis: Cesarean section ectopic pregnancy Symptoms: Amenorrhea Medication:— Clinical Procedure: Exploratory laparotomy • MRI • ultrasonography Specialty: Obstetrics and Gynecology OBJECTIVE: Management of emergency care BACKGROUND: Low- and middle-income countr...
Autores principales: | , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774991/ https://www.ncbi.nlm.nih.gov/pubmed/33370250 http://dx.doi.org/10.12659/AJCR.927496 |
_version_ | 1783630378653712384 |
---|---|
author | Erem, Anna Sarah Konney, Thomas Okpoti Appiah-Kubi, Adu Ankomah, Kwasi Amankwa, Adu Tutu Annan, John Jude Kweku Tawiah, Augustine Amoako-Adjei, Benjamin Kwame Lartey, Kwabena Fosu Lawrence, Emma R. |
author_facet | Erem, Anna Sarah Konney, Thomas Okpoti Appiah-Kubi, Adu Ankomah, Kwasi Amankwa, Adu Tutu Annan, John Jude Kweku Tawiah, Augustine Amoako-Adjei, Benjamin Kwame Lartey, Kwabena Fosu Lawrence, Emma R. |
author_sort | Erem, Anna Sarah |
collection | PubMed |
description | Patient: Female, 35-year-old Final Diagnosis: Cesarean section ectopic pregnancy Symptoms: Amenorrhea Medication:— Clinical Procedure: Exploratory laparotomy • MRI • ultrasonography Specialty: Obstetrics and Gynecology OBJECTIVE: Management of emergency care BACKGROUND: Low- and middle-income countries (LMICs) account for the overwhelming majority of maternal deaths worldwide. Cesarean section rates have increased globally over the last 10 years, including in LMICs, and are an important intervention to decrease neonatal and maternal mortality. However, cesarean sections also contribute to increased complications in subsequent pregnancies, including invasive placentation and cesarean scar ectopic pregnancies (CSEP). Potential CSEP complications include rupture of the uterus, bladder invasion, and maternal mortality. CASE REPORT: We present the case of a 35-year-old Ghanaian woman (gravidity 5, parity 3) with a positive urine pregnancy test and 2 months of amenorrhea. Ultrasound scanning demonstrated a gestational sac with a fetal pole and absent cardiac activity located in the lower uterine segment. Myometrium infiltration was present, with only 2 mm of anterior myometrium between the gestational sac and the urinary bladder. Owing to concern for CSEP with uncertain bladder invasion, a pelvic MRI was obtained for preoperative planning. Following the MRI, which demonstrated an intact bladder, the patient underwent an uncomplicated exploratory laparotomy and excision of the CSEP. CONCLUSIONS: In LMICs, pelvic ultrasound continues to be the diagnostic tool of choice for CSEP. However, in cases with diagnostic uncertainty or possible bladder invasion, MRI is an additional imaging tool that can optimize preoperative planning and minimize the risk of maternal mortality and potential post-surgical complications. |
format | Online Article Text |
id | pubmed-7774991 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-77749912021-01-07 Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana Erem, Anna Sarah Konney, Thomas Okpoti Appiah-Kubi, Adu Ankomah, Kwasi Amankwa, Adu Tutu Annan, John Jude Kweku Tawiah, Augustine Amoako-Adjei, Benjamin Kwame Lartey, Kwabena Fosu Lawrence, Emma R. Am J Case Rep Articles Patient: Female, 35-year-old Final Diagnosis: Cesarean section ectopic pregnancy Symptoms: Amenorrhea Medication:— Clinical Procedure: Exploratory laparotomy • MRI • ultrasonography Specialty: Obstetrics and Gynecology OBJECTIVE: Management of emergency care BACKGROUND: Low- and middle-income countries (LMICs) account for the overwhelming majority of maternal deaths worldwide. Cesarean section rates have increased globally over the last 10 years, including in LMICs, and are an important intervention to decrease neonatal and maternal mortality. However, cesarean sections also contribute to increased complications in subsequent pregnancies, including invasive placentation and cesarean scar ectopic pregnancies (CSEP). Potential CSEP complications include rupture of the uterus, bladder invasion, and maternal mortality. CASE REPORT: We present the case of a 35-year-old Ghanaian woman (gravidity 5, parity 3) with a positive urine pregnancy test and 2 months of amenorrhea. Ultrasound scanning demonstrated a gestational sac with a fetal pole and absent cardiac activity located in the lower uterine segment. Myometrium infiltration was present, with only 2 mm of anterior myometrium between the gestational sac and the urinary bladder. Owing to concern for CSEP with uncertain bladder invasion, a pelvic MRI was obtained for preoperative planning. Following the MRI, which demonstrated an intact bladder, the patient underwent an uncomplicated exploratory laparotomy and excision of the CSEP. CONCLUSIONS: In LMICs, pelvic ultrasound continues to be the diagnostic tool of choice for CSEP. However, in cases with diagnostic uncertainty or possible bladder invasion, MRI is an additional imaging tool that can optimize preoperative planning and minimize the risk of maternal mortality and potential post-surgical complications. International Scientific Literature, Inc. 2020-12-28 /pmc/articles/PMC7774991/ /pubmed/33370250 http://dx.doi.org/10.12659/AJCR.927496 Text en © Am J Case Rep, 2020 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Erem, Anna Sarah Konney, Thomas Okpoti Appiah-Kubi, Adu Ankomah, Kwasi Amankwa, Adu Tutu Annan, John Jude Kweku Tawiah, Augustine Amoako-Adjei, Benjamin Kwame Lartey, Kwabena Fosu Lawrence, Emma R. Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title | Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title_full | Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title_fullStr | Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title_full_unstemmed | Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title_short | Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana |
title_sort | use of magnetic resonance imaging (mri) in the management of diagnostic uncertainty in low-resource settings: a case report of cesarean ectopic pregnancy in a tertiary hospital in ghana |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774991/ https://www.ncbi.nlm.nih.gov/pubmed/33370250 http://dx.doi.org/10.12659/AJCR.927496 |
work_keys_str_mv | AT eremannasarah useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT konneythomasokpoti useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT appiahkubiadu useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT ankomahkwasi useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT amankwaadututu useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT annanjohnjudekweku useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT tawiahaugustine useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT amoakoadjeibenjaminkwame useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT larteykwabenafosu useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana AT lawrenceemmar useofmagneticresonanceimagingmriinthemanagementofdiagnosticuncertaintyinlowresourcesettingsacasereportofcesareanectopicpregnancyinatertiaryhospitalinghana |