Management of a Viable Cesarean Scar Pregnancy: A Case Report

Abstract

The incidence of cesarean scar pregnancy (CSP), which was extremely rare till recent times, has been rising steadily. We have more of such cases being published in medical literature now. A 38-year-old woman with a past history of previous three cesarean sections presented with five weeks pregnancy and complaints of bleeding per vaginum associated with mild lower abdominal discomfort. The diagnosis of CSP with a live fetus within the gestational sac was made on a transvaginal ultrasound examination and later confirmed with a magnetic resonance imaging (MRI). The management involved injecting potassium chloride into the gestational sac and a combination of local and systemic methotrexate administration. The patient was followed-up by monitoring the beta human chorionic gonadotropin level until it reached non pregnant level and followed-up with scan and MRI until complete resolution of the pregnancy sac. Due to the rarity of this condition, there are no specific guidelines available for its management.

Keywords: Dilatation and Curettage; Laparoscopy; Methotrexate; Pregnancy, Ectopic.

Figure 1

Transvaginal scan showing the gestational sac with fetal pole at the scar area.

Figure 2

Transvaginal scan with a color doppler showing the gestational sac with a fetal pole at the previous scar area.

Figure 3

Transvaginal scan 16 weeks after the treatment showing a minimal hypoechoeic area at the scar area. The patient was initially using barrier method of contraception but later underwent laparoscopic tubal ligation.