CME Journal of Clinical Case Reports
ISSN: 3067-7998 | DOI: 10.64030/3067-7998
John C Irechukwu, Nwabunike Okeke, Eziaha Ede, Bartholomew Olinya, Amuche Nwafor, Ayodele Olaleye, Ali Vincent, Eke Ifeanyi and Boniface Ejikeme
Background Adenomyosis has been known to affect fertility and it is a common cause of recurrent miscarriages. Pregnancy with co-existing adenomyosis requires multidisciplinary approach of management involving the attending Obstetricians and Gynaecologists, Radiologists, Clinical psychologists, Neonatologists and other ancillary health workers due to increased risk of miscarriages and fetal wastage associated with pregnancies in an adenomyomatous uterus. The risk factors for adenomyosis include previous uterine surgeries, increased maternal age, multiparty and myomatous uterus. It has also been seen in young women as an incidental finding during evaluation for infertility. It is not life-threatening condition, but it could reduce the woman’s quality of life because of its distressing symptoms. This case report was aimed at highlighting the importance of early ultrasound monitoring in management of patients with recurrent miscarriages.
Case Report We present a booked 29year old G5P0+4 who presented with bleeding per vaginum at a gestational age of 12 weeks + 4 days on the day of presentation. She was managemed as a case of threatened miscarriage, and was placed on tablet Vasoprin 75mg daily for 2 weeks, oral progestogen dydrogesterone (duphaston) 20mg daily for 4 weeks. She had ultrasound indicated cervical cerclage at GA of 14 weeks, following progressive shortening of the cervix. She had an elective caesarean section at GA of 37 weeks due to mal-presentation, with intraoperative findings of features of adenomyosis. The delivery was complicated by primary postpartum haemorrhage due to uterine atony which was promptly managed by the use of uterotonics. She received 2 units of blood. The postoperative period was otherwise uneventful and she was discharged home on day 7 post-partum.