03 July 2024
: Case report
Direct Visualization of a Cesarean Scar Ectopic Pregnancy After Medical Management
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Clinical situation which can not be reproduced for ethical reasons, Rare coexistence of disease or pathology
Amy Hua1EF, Catherine Igel2BD, Dmitry Fridman2BD, Ivan Ngai1AE*DOI: 10.12659/AJCR.944396
Am J Case Rep 2024; 25:e944396
Abstract
BACKGROUND: Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy that can result in severe maternal morbidity and mortality. Medical, surgical, and minimally invasive therapies alone or in combination have been described in the literature, but the optimal treatment modality of cesarean scar ectopic pregnancies is unknown. Limited information exists on the course of cesarean scar ectopic pregnancy following treatment with cytotoxic agents.
CASE REPORT: We present a case of a woman with a history of multiple cesarean births that was provided with medical abortion for an unintended pregnancy. However, upon follow-up, the patient was found to have a cesarean scar ectopic pregnancy. Following the diagnosis, she was treated by multi-dose systemic methotrexate-leucovorin and with ultrasound-guided intra-gestational sac injection of potassium chloride. After resolution of beta human gonadotropin levels, ultrasound follow-up revealed persistence of residual tissue in the cesarean scar. The patient elected for resection of the residual tissue with operative hysteroscopy. We report a novel hysteroscopic finding after medical treatment of a cesarean scar ectopic pregnancy with intra-gestational sac injection of potassium chloride.
CONCLUSIONS: Direct visualization of the intra-abdominal cavity and intra-uterine cavity showed that combined medical management with systemic methotrexate and local potassium chloride injection is an effective treatment modality for live cesarean scar ectopic pregnancies, with minimal anatomical harm. Hysteroscopic resection offers a safe and effective approach for removal of persistence of residual tissue.
Keywords: Hysteroscopy, Pregnancy, Ectopic
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.943655
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.943867
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.943826
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.944422
Most Viewed Current Articles
07 Mar 2024 : Case report
38,869
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
31,214
DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
23 Feb 2022 : Case report
17,958
DOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250
19 Jul 2022 : Case report
17,875
DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128