Caesarean scar pregnancy.

Abstract

A healthy 32-year-old woman was found on ultrasound to have a live eight week-sized pregnancy implanted in her previous Caesarean section scar (Figure 1; B=bladder, U=uterus, GS=gestational sac). The serum β-hCG level was 95 687 IU/L. Potassium chloride and methotrexate were injected intra-amniotically; the β-hCG level fell, but then plateaued prompting administration of intramuscular methotrexate. Although the β-hCG level declined further, the pregnancy persisted as a 4 cm mass with highly vascular flow, warranting surgical removal. This was carried out using a combined laparoscopic-hysteroscopic approach (Figure 2). Approximately 18 months later, the patient delivered a healthy infant at term by Caesarean section.Figure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT) Caesarean scar pregnancy is a rare and life-threatening event with a reported incidence ranging from 1:1800 to 1:2216 normal pregnancies.1.Rotas M.A. Haberman S. Levgur M. Cesarean scar ectopic pregnancies:etiology, diagnosis and management.Obstet Gynecol. 2006; 107: 1373-1381Crossref PubMed Scopus (488) Google Scholar Management options include medical therapy, surgery, or a combined approach.1.Rotas M.A. Haberman S. Levgur M. Cesarean scar ectopic pregnancies:etiology, diagnosis and management.Obstet Gynecol. 2006; 107: 1373-1381Crossref PubMed Scopus (488) Google Scholar, 2.Osborn D.A. Williams T.R. Craig B.M. Cesarean scar pregnancy: sonographic and magnetic resonance imaging findings, complications and treatment.J Ultrasound Med. 2012; 31: 1449-1456Crossref PubMed Scopus (101) Google Scholar, 3.Wang G. Liu X. Bi F. Yin L. Sa R. Wang D. Yang Q. Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy.Fertil Steril. 2014; 101: 1501-1507Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Consent to publish these images was obtained from the patient.