Use of MRI in the management of diagnostic uncertainty in low-resource settings: A case report of cesarean ectopic pregnancy in a tertiary hospital in Ghana

11/06/2020: Successfully approved the finalized version with the American Medical Journal of Case Reports.

The publication is currently in the “In-Press” and is scheduled for the final publication on 12/20/2020.


Anna Sarah Erem, Thomas Okpoti Konney, Adu Appiah-Kubi, Kwasi Ankomah, Adu Tutu Amankwa, John Jude Kweku Annan, Augustine Tawiah, Benjamin Kwame Amoako-Adjei, Kwabena Fosu Lartey, Emma R Lawrence

Corresponding Author: Anna Sarah Erem
Conflict of interest: None declared

Objective: Management of emergency care

 Obstetrics and Gynecology, Saba University School Of Medicine, Saba, Netherlands Antilles

Am J Case Rep 2020; 21:e927496, DOI: 10.12659/AJCR.927496

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.

Keywords: Cesarean Section; Ghana; Magnetic Resonance Imaging; Pregnancy, Ectopic; Ultrasonography

Big Dreams: I intend to use this case report-based project as a platform to generate ideas for further improvements in communities with low-resources.

More articles

Gynecologic Oncology Sub-Specialty Training at Komfo Anokye Teaching Hospital (KATH) in Ghana: Overcoming 21st Century Challenges with Global Partnerships. Frontiers in Public Health

Anna Sarah Erem, Adu Appiah-Kubi, Thomas Okpoti Konney, Kwabena Amo-Antwi, Sarah G. Bell, Timothy R. B. Johnson, Carolyn Johnston, Alexander Tawiah Odoi and Emma R. Lawrence

The leading cause of cancer deaths in Ghanaian women is cervical cancer in part due to late presentation. This, in addition to the chronic late presentation of other gynecologic malignancies, demonstrates a crisis surrounding women’s health in Africa. As a collaboration of US and Ghanaian medical professionals, our paper investigates methods of improving health outcomes for women in Ghana. The gynecologic oncology fellowship program we discuss was developed as part of a longitudinal, multi-decade, partnership between the University of Michigan (MM) and the Ghana College of Physicians and Surgeons.