Successful conservative management of a viable Cesarean scar pregnancy: A case report

Abstract

Cesarean scar pregnancy is the one of the rarest forms of ectopic pregnancy and is associated with severe complications, such as uncontrollable bleeding and uterine rupture. However optimal treatment has not been established. We present here a case of ectopic pregnancy in the previous Cesarean scar treated successfully by uterine artery embolization in combination with subsequent intra-cardiac potassium chloride and intra-sac methotrexate injection without surgical or invasive intervention at 9+3 weeks' gestational age. Th is is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Keywords Copyright © 2012. Korean Society of Obstetrics and GynecologyCesarean scar pregnancy is a rare form of ectopic pregnancy implanted in the myometrium at the site of a previous Cesarean section scar [1,2]. These conditions are challenging to diagnose and have higher risk of bleeding and uterine rupture [3,4]. Due to the severity of complications and possibility of hysterectomy, early diagnosis is critical [5]. However, there is still no standard treatment modality. We report here a case of viable Cesarean scar pregnancy successfully treated with uterine artery embolization followed by local injection of potassium chloride (KCl) and methotrexate (MTX) under sonographic guidance at 9+3 weeks' gestational age which was advanced compared with those of previous reported cases. Case ReportA 34-year-old woman, gravida 2 para 1, visited outpatient clinic in Seoul National University Hospital for suspected Cesarean scar pregnancy. She had been naturally pregnant and underwent Cesarean delivery due to placenta previa on 2004. The next pregnancy was on December, 2006. But she was diagnosed with hydatidiform mole and treated with curettage and systemic methotrexate injection. After 1 year of treatment and follow-up, she was diagnosed with a cure. After that, she was failed to get pregnant during 2 years and underwent infertility examination. On hysterosalpingogram, right hydrosalpinx was noted and pelviscopic right salpingectomy was done on 2009. She underwent 3 times of in vitro fertilization cycle which were all failed. And then, she got taken thawing embryo transfer on 5, November, 2010 and conceived successfully. The β-subunit of serum human chorionic gonadotropin (β-hCG) values had been elevated as in normal pregnancy, and there were no signs or symptoms of an ectopic pregnancy. At eight weeks' gestational age, the gestational sac was noted to be located into the previous Cesarean scar with normal fetal heart beat and appropriate crown-rump length. On December 17, she was referred to our hospital. The levels of CASE REPORT Korean J Obstet Gynecol 2012;55(4):274-277 http://dx