Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

Area of Science:

• Reproductive Medicine
• Gynecology
• Maternal-Fetal Medicine

Background:

• Cesarean scar pregnancy (CSP) incidence is rising with increased cesarean deliveries.
• CSP often requires surgical intervention, frequently resulting in hysterectomy.
• Recurrence of CSP is exceptionally rare.

Observation:

• A 30-year-old woman with a history of two prior cesarean deliveries and one CSP presented with a recurrent cesarean scar ectopic pregnancy (RCSP).
• Diagnosis was made via transvaginal ultrasound at 5 weeks and 3 days gestation, with a serum beta-human chorionic gonadotropin (β-hCG) level of 54,295 IU/L.
• Previous CSP was treated with uterine artery embolization and systemic methotrexate.

Findings:

• The current RCSP was promptly diagnosed and managed conservatively with two doses of systemic methotrexate.
• Serum β-hCG levels became undetectable within 7 weeks of treatment.
• This conservative approach successfully resolved the RCSP without surgical intervention.

Implications:

• Early and careful monitoring with transvaginal ultrasound is crucial for subsequent pregnancies in women with a history of CSP.
• Prompt diagnosis allows for conservative management options like methotrexate for RCSP.
• Conservative treatment of RCSP can prevent the need for hysterectomy and preserve reproductive potential.