Medical Management of Cesarean Scar Ectopic Pregnancy: A Unique Approach

Abstract

One of the rarest types of ectopic pregnancy, with an incidence of 1:1,800, is cesarean scar ectopic pregnancy. Here, we report the case of a 28-year-old woman who had undergone two previous cesarean sections. She arrived at our labor room with per vaginal spotting and abdominal pain with an ultrasound that revealed a cesarean scar ectopic pregnancy. The initial beta-human chorionic gonadotropin (β-hCG) value upon admission was 27,133 mIU/mL. Her ultrasound findings were confirmed with magnetic resonance imaging. Opting for combined medical management, we successfully treated her using systemic methotrexate and mifepristone, avoiding surgical intervention despite high β-hCG values. There is currently no established standardized treatment for cesarean scar ectopic pregnancies, and we feel that treatment must be tailored to every patient's individual needs. Our experience suggests that combining mifepristone and systemic methotrexate can be an effective approach with better curative effects, emphasizing the need for further research.

Keywords: gynecology and obstetrics; medical management; methotrexate ectopic; mifepristone; scar ectopic pregnancy.

Figure 1. T2-weighted sagittal magnetic resonance imaging showing the gestational sac measuring approximately 1.15 cm × 2.39 cm.

Figure 2. T2-weighted axial magnetic resonance imaging with the red arrow representing the gestational sac.

Figure 3. Graphical representation of β-hCG values on various treatment days with blue arrows indicating when methotrexate was given.

β-hCG = beta-human chorionic gonadotropin; D = day