Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High β-hCG.

Rodney Mclaren,Mohamad Irani,Sandra Mccalla

doi:10.1155/2015/959876

Abstract

Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP with β-hCG higher than 62,000 IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitative β-hCG of 144,337 IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Her β-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very high β-hCG and fetal heart activity can be offered conservative or fertility preserving management.

Highlights

Cesarean scar ectopic pregnancy (CSP) is considered one of the rarest types of ectopic pregnancies
There are many conservative treatment modalities described in the literature including systematic methotrexate, local methotrexate, bilateral uterine arteries embolization (UAE), and combined UAE and local methotrexate
There are no previous reports of conservative management for advanced CSP with extremely high β-hCG level (>100,000 IU/L) and detected fetal heart activity

Summary

Introduction

Cesarean scar ectopic pregnancy (CSP) is considered one of the rarest types of ectopic pregnancies. Its incidence has been reported as 1/2200–1/1800 pregnancies [1]. This incidence is increasing possibly due to the increase in cesarean section rates. Diagnosis is prudent to avoid severe complications such as uterine rupture and severe hemorrhage. There are many conservative treatment modalities described in the literature including systematic methotrexate, local methotrexate, bilateral uterine arteries embolization (UAE), and combined UAE and local methotrexate. There are no previous reports of conservative management for advanced CSP with extremely high β-hCG level (>100,000 IU/L) and detected fetal heart activity. We are reporting the first case of CSP with β-hCG of 144,337 IU/L and a detected fetal heart activity that was successfully treated with uterine artery embolization and systemic methotrexate

Case Report

Findings

Discussion