Cesarean scar ectopic pregnancies may be difficult to diagnose and may result in uterine rupture or hysterectomy. Based on location and vascularity, especially in the presence of fetal cardiac activity, local treatment with transvaginal ultrasound-guided injection of methotrexate is an excellent option which also optimizes the chance for fertility preservation.
Problem: prevalence likely to rise
Nontubal ectopic pregnancies remain a significant treatment challenge. Cases of cesarean scar ectopic pregnancies (CSP) have increased significantly; this may be related to the growing number of cesarean deliveries that are being performed or to improved diagnosis. No standard treatment protocol has yet been established. Adverse sequelae for both untreated and treated CSPs include uterine rupture, severe hemorrhage, and hysterectomy.
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A 27-year-old woman, G4P2012, had complaints of spotting and a missed period. Her history was notable for 2 cesarean deliveries and a dilation and curettage for a spontaneous abortion. Ultrasound imaging was suspicious for an ectopic pregnancy that was 6 weeks 3 days and located between the uterus and bladder at the site of the cesarean scar ( Figure 1 ) . Three-dimensional ultrasound imaging confirmed the extrauterine location ( Figure 2 ) . Fetal cardiac activity was 120 beats per minute. The patient’s serum beta-human chorionic gonadotropin level was 32,673 mIU/mL.
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