Successful selective reduction of a heterotopic cesarean scar pregnancy in the second trimester: a case report and review of the literature

Abstract

BackgroundHeterotopic cesarean scar pregnancy is a cesarean scar pregnancy combined with an intrauterine pregnancy that predisposes a woman to life-threatening complications such as uterine rupture and massive bleeding. Preservation of the intrauterine pregnancy in heterotopic cesarean scar pregnancy is a great challenge.Case presentationWe report a case of a 33-year-old woman with heterotopic cesarean scar pregnancy after IVF-embryo transfer (ET). Expectant management was carried out with early diagnosis of heterotopic cesarean scar pregnancy (HCSP), and selective fetal reduction of cesarean scar pregnancy (CSP) was performed by ultrasound-guided intrathoracic injection of potassium chloride (KCl) at 16 + 4 weeks of gestation due to aggravation of CSP. Preservation of the intrauterine pregnancy was successful and a healthy baby was delivered by cesarean section at 37 + 6 weeks of gestation.ConclusionsHeterotopic cesarean scar pregnancy is an extremely rare form of heterotopic pregnancy. Patients should be appropriately counseled regarding the different treatment options available. An ultrasound-guided injection of potassium chloride may constitute a safe, minimally invasive and reliable way to terminate the heterotopic gestation and preserve the intrauterine pregnancy. Intensive management should be performed during the ongoing pregnancy and cesarean section.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1171-x) contains supplementary material, which is available to authorized users.

Selective Reduction of a Heterotopic Cesarean Scar Pregnancy Complicated by Septic Abortion

“…Selective reduction of heterotopic cesarean scar pregnancies via abortifacient injection, embryo aspiration, or both has been shown in the literature to be effective with multiple case reports citing success [ 1 – 5 ]. There are three case reports describing the successful management of a heterotopic CSP with selective reduction via potassium chloride injection of the cesarean scar pregnancy with preservation of the intrauterine gestation [ 1 , 4 , 6 ]. Hsieh et al presented a successful case of embryo aspiration under sonographic guidance for selective embryo reduction in the setting of a heterotopic cesarean scar pregnancy with a combined intrauterine pregnancy [ 5 ].…”

“…The successful selective reduction of a heterotopic cesarean scar pregnancy via ultrasound guided potassium chloride (KCl) injection has even been reported in the second trimester [ 6 ]. Our case presents complications that arose from conservative management of sepsis as a result of selective reduction of a heterotopic cesarean scar pregnancy with sepsis and postprocedure bacteremia.…”

Embarazo heterotópico: manejo conservador con inyección local de KCl

“…En las gestantes en las cuales un embarazo ectópico en cicatriz de cesárea coexiste con un embarazo intrauterino, se puede considerar la inyección local guiada por ultrasonido de cloruro de potasio (KCL) o la aspiración del saco gestacional. El uso de Metrotexate local intrasacular está contraindicado, tal como fue el caso que hemos presentado 4 .…”

Heterotopic caesarean section scar pregnancy after embryo transfer: a case report successfully treated with aspiration

“…Thus, different attempts have been described, varying from expectant management to clinical or surgical intervention -ultrasound guided aspiration or infusion of potassium chloride or methotrexate and hysterectomy. 7,8 On this report, we intend to describe a HCSP resulting from a double embryo transfer treated successfully by embryo reduction performed by ultrasound guided aspiration of the ectopic gestational sac. On this case, the patient evolved to a normal gestation up to term, when a healthy baby was delivered.…”