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

Abstract

Background: Heterotopic 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 presentation: We 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.

Conclusions: Heterotopic 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.

Keywords: Expectant management; Heterotopic cesarean scar pregnancy; Potassium chloride; Selective fetal reduction.

Fig. 1

Diagnosis of cesarean heterotopic pregnancy via transvaginal ultrasonography at 11 + 1 weeks’ gestation. Myometrial layer of cesarean scar 4 mm

Fig. 2

Heterotopic complete placenta previa and placenta accreta at ultrasonography at 16+3 weeks’ gestation

Fig. 3

Magnetic resonance imaging findings at 37 weeks’ gestation. Heterotopic complete placenta previa and placenta accrete, dead fetus and placenta covering the internal cervical os (white arrow). Thin myometrial layer of cesarean scar (1.3 mm, black arrow)