Abstract
Cesarean scar pregnancy (CSP) is a very serious complication of a prior cesarean delivery. The major risks associated with CSP are uncontrolled hemorrhage and uterine rupture, potentially leading to future infertility. Management of CSP remains a major obstetric challenge without a well-defined therapeutic procedure. Dilation & curettage is a commonly used procedure for the treatment of CSP. However, it can be ineffective and often leads to definite infertility. Therefore, we present a case of the successful use of an alternative procedure, Myosure® hysteroscopy, in the treatment of CSP. We herein report the case of a 32-year-old G5P3013 woman who presented with vaginal bleeding and past history of three cesarean sections. She was found to have a CSP with fetal pole and cardiac activity at 6 weeks 2 days. The patient was initially treated with a systemic methotrexate injection, but there was persistence of cardiac activity. A second course of methotrexate was administered into the gestational sac, which systemically led to successful fetal cardiac arrest and downtrend of beta-human chorionic gonadotropin (HCG) level. A dilation & curettage procedure was not successful in removing products of conception. A Myosure hysteroscopy procedure, however, was successful in removing products of conception. The patient was discharged after a negative ultrasound and beta-HCG level. In our review of the literature, we found that there is no general consensus on the management of cesarean scar ectopic pregnancies. To date, there is no literature cited about the use of Myosure for cesarean scar ectopic pregnancies. However, our case suggests that Myosure can be effective for CSP and this warrants a larger-scale controlled study to better evaluate this as a treatment for this condition.
Highlights
Cesarean scar ectopic pregnancy was first published in the literature in 1978 [1]
We report the case of a 32year-old G5P3013 woman who presented with vaginal bleeding and past history of three cesarean sections
A second course of methotrexate was administered into the gestational sac, which systemically led to successful fetal cardiac arrest and downtrend of beta-human chorionic gonadotropin (HCG) level
Summary
Cesarean scar ectopic pregnancy was first published in the literature in 1978 [1]. It has since been discovered that the incidence of cesarean scar ectopic pregnancy ranges from approximately 1/800 to 1/2500 of all pregnancies [2,3]. It can often fail to remove all of the fetal tissue from the uterus and cause further complications such as decreased fertility This case report describes a woman with cesarean scar ectopic pregnancy who had multiple treatments for removal of the gestational sac. She underwent methotrexate injection twice with failure both times. The patient underwent a transvaginal and transabdominal ultrasound, which showed a cesarean scar pregnancy with a present cardiac activity of 101 BPM in a single gestational sac located in the mid-uterus (Figure 1). Ultrasound revealed a complex fluid collection in the endometrium, with a thickened endometrial layer, most likely due to retained products of conception She underwent the final management strategy for this condition, a Myosure hysteroscopy procedure.
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