Successful Full-Term Delivery via Selective Ectopic Embryo Reduction Accompanied by Uterine Cerclage in a Heterotopic Cesarean Scar Pregnancy: A Case Report and Literature Review

Abstract

Heterotopic cesarean scar pregnancy (HCSP) is a combination of cesarean scar pregnancy (CSP) and intrauterine pregnancy (IUP). Cesarean scar pregnancy is accompanied by life-threatening complications, such as uterine rupture and massive bleeding. Herein, we present a case of HCSP treated with selective potassium chloride injection into the CSP under ultrasonography in association with uterine cerclage to control vaginal bleeding; this led to a successful IUP preservation and full-term delivery. Additionally, we will review several previous reports on HCSP management, including our case.

Keywords: arteriovenous malformation; ectopic pregnancy; heterotopic cesarean section scar pregnancy; selective embryo reduction.

Figure 1

Initial examination. (a) Initial transvaginal ultrasound examination at 6⁺¹ GW. *—intrauterine gestational sac; †—CSP. (b) Description of sagittal plane.

Figure 2

Schematic procedures for embryo reduction. (a) A uterine sound was inserted to reach the CSP. (b) A spinal needle bent at an equal angle to the sound was then guided along to locate the CSP. (c) Potassium chloride was injected via spinal needle into the CSP.

Figure 3

Transvaginal ultrasonography examination at 7⁺¹ GW. *—intrauterine gestational sac; †—RGT; CSP—cesarean scar pregnancy; GW—gestational weeks; RGT—remnant gestational tissue.

Figure 4

Management of arterio-venous malformation after selective CSP embryo reduction. (a) Ultrasonography to visualize RGT with cervical shortening at 10⁺³ GW before cervical cerclage. The RGT went into the uterine cervical internal os. (b) Transvaginal ultrasonography at 12⁺³ GW after the cerclage. (c) Effect of cervical cerclage role on HCSP management (details are written in the discussion section). (d) Ultrasound examination at 24⁺³ GW. Enlarged arterio-venous circulation was observed in the demised CSP (†); asterisk (*) indicates the fetal foot. CSP—cesarean scar pregnancy; GW—gestational weeks; RGT—remnant gestational tissue.