A case report of pregnancy at incision site treated with methotrexate

Introduction: Cesarean scar ectopic pregnancy is rare and is associated with serious complications if not treated early. Among treatment methods, the expectant treatment is associated with high risk for failure and complications. In patients with stable beta-human chorionic gonadotropin (βhCG) titers < 5000, gestational age < 8 weeks, and absence of fetal heart tones, administration of systemic methotrexate is associated with high success rate compared to surgical methods, and it is more likely to preserve fertility. In this article, we present a case of cesarean scar ectopic pregnancy treated with a single dose of methotrexate. Case presentation: The patient was a 33-year-old woman (gravidity: 3, parity: 2, gestation: 7 weeks and 4 days) with history of two cesarean sections. She was admitted with abdominal pain, spotting, transvaginal ultrasonography based on a gestational sac implanted in cesarean scar, and βhCG titers of 3900. According to the patient's clinical condition, she was candidate for medical treatment and received one dose of methotrexate, then βhCG titers progressively reduced, and the patient was discharged in good general condition. Conclusion: Medical treatment of cesarean scar ectopic pregnancy, in addition to efficacy and reduction of complications, can preserve fertility in the patient.

Abstract licence: CC BY-ND

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