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Medical Treatment in Cesarean Scar Pregnancy with Fetal Heart Activity and High Level of Serum β-hCG: A Case Report

[ Vol. 17 , Issue. 2 ]

Author(s):

Nafiseh Saghafi, Leila Pourali*, Atiyeh Vatanchi and Zahra Rastin   Pages 185 - 188 ( 4 )

Abstract:


Background: Cesarean scar pregnancy (CSP) is the implantation of the gestational sac in the hysterotomy scar. The optimal treatment for a cesarean scar pregnancy is unclear and therapy should be selected according to the patients' clinical presentation. The aim of this study was to report a successful medical treatment of a cesarean scar pregnancy with fetal heart activity and a very high level of beta-human chorionic gonadotropin (β-hCG).

Case Presentation: A 38-year-old woman referred for a routine prenatal visit after 2 months of menstrual retard and a positive pregnancy test. She had a history of 3 cesarean sections and a uterine curettage. Ultrasonography revealed cesarean scar ectopic pregnancy. The serum level of β-hCG was 109063 mIU/ml. Two doses of systemic methotrexate therapy and intragestational sac injection of methotrexate and potassium chloride were administered. Eight weeks after the initial treatment, the β-hCG level became undetectable.

Conclusion: Combined medical treatment with local and systemic MTX administration may be a successful treatment with low complications even in the presence of high serum β-hCG level.

Keywords:

Cesarean section, ectopic pregnancy, methotrexate, serum β-hCG level, ultrasonography, uterine curettage.

Affiliation:

Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad



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