Abstract
BackgroundHeterotopic cesarean scar pregnancy is a cesarean scar pregnancy combined with an intrauterine pregnancy that predisposes a woman to life-threatening complications such as uterine rupture and massive bleeding. Preservation of the intrauterine pregnancy in heterotopic cesarean scar pregnancy is a great challenge.Case presentationWe report a case of a 33-year-old woman with heterotopic cesarean scar pregnancy after IVF-embryo transfer (ET). Expectant management was carried out with early diagnosis of heterotopic cesarean scar pregnancy (HCSP), and selective fetal reduction of cesarean scar pregnancy (CSP) was performed by ultrasound-guided intrathoracic injection of potassium chloride (KCl) at 16 + 4 weeks of gestation due to aggravation of CSP. Preservation of the intrauterine pregnancy was successful and a healthy baby was delivered by cesarean section at 37 + 6 weeks of gestation.ConclusionsHeterotopic cesarean scar pregnancy is an extremely rare form of heterotopic pregnancy. Patients should be appropriately counseled regarding the different treatment options available. An ultrasound-guided injection of potassium chloride may constitute a safe, minimally invasive and reliable way to terminate the heterotopic gestation and preserve the intrauterine pregnancy. Intensive management should be performed during the ongoing pregnancy and cesarean section.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1171-x) contains supplementary material, which is available to authorized users.
Highlights
Heterotopic cesarean scar pregnancy is a cesarean scar pregnancy combined with an intrauterine pregnancy that predisposes a woman to life-threatening complications such as uterine rupture and massive bleeding
We used a list of keywords, including “Ectopic pregnancy,” “Cesarean section scar,” and “Heterotopic cesarean scar pregnancy,” to perform an extensive search of the literature; and we found fewer than 25 cases of heterotopic cesarean scar pregnancy (HCSP) having been reported
We report 1 case of twin HCSP in a patient after IVF-embryo transfer (ET)
Summary
Heterotopic cesarean scar pregnancy is an extremely rare form of heterotopic pregnancy. The desire to preserve the intrauterine pregnancy in cases of HCSP is a great challenge, and no universal management guidelines have been established. The current lack of data with respect to best practices should encourage publication of more individual case reports and the establishment of further multicenter studies in the future. Based on previously reported cases and our case, injection of potassium chloride may be a safe, minimally invasive and reliable way to terminate the heterotopic gestational sac and preserve the intrauterine pregnancy. As retained gestational tissue may contribute to uterine rupture and massive uterine bleeding during an ongoing pregnancy and cesarean section, intensive management should be performed. All Reported Cases of Heterotopic Cesarean Scar Pregnancy.
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