Type 2 cesarean section scar pregnancy managed by hysteroscopic resection and methotrexate: A case report

Abstract

Background: Diagnosis and management of cesarean scar ectopic pregnancy (CSP) remain challenging. We describe ultrasound diagnosis followed by hysteroscopic resection and methotrexate administration. Case presentation: A 42-year-old woman, para 2+1, presented with 8 weeks of amenorrhea and vaginal bleeding. She had two previous cesarean deliveries. Initial ultrasound suggested an incomplete miscarriage and beta human chorionic gonadotropin (β-HCG) was 46,129 mIU/ml. After failed medical management, repeat ultrasound diagnosed CSP. Hysteroscopic resection was performed, and she received methotrexate, resulting ß-HCG resolution. Conclusion: Though rare, CSP should be entertained in any woman presenting with vaginal bleeding with a history of cesarean delivery. Hysteroscopic resection with methotrexate provides good fertility-preserving modality for management