Rare Cesarean Section Scar Ectopic Pregnancy Successfully Treated by Methotrexate: A Case Report

Abstract

An ectopic pregnancy embedded in a C-section scar is considered an uncommon and complex sub-type of ectopic pregnancy. This particular condition requires an increased level of clinical suspicion, the use of specific diagnostic tools, and the implementation of customized care measures. Here we present a case of a 37-year-old lady with a history of 3 C-sections presented to the ER department with an acute attack of pain and vaginal bleeding for 1 hour before admission on day 19 of a regular cycle. She gave a six-month history of intermenstrual bleeding and chronic pelvic pain. Her previous bacteriological and pap smears were normal. An earlier pelvic scan showed an Rt ovarian case, a thickened endometrium, and a small mural fibroid. Upon admission, B-HCG was positive; transvaginal ultrasound was negative. B-HCG titers confirmed the EP, and an MRI scan confirmed CsEP. She was managed medically with methotrexate and showed a good response. Clinicians must exercise diligence in evaluating patients with a prior history of cesarean sections and who are currently experiencing symptoms of pelvic pain and irregular uterine bleeding. The timely identification and intervention of this complex ailment are crucial to minimize the potential hazards involved and optimize the patient's overall prognosis.