Successful conservative treatment of a caesarean scar twin pregnancy with systemically administered methotrexate and subsequent uterine artery embolization: a rare case report

Caesarean scar pregnancy is a very rare form of ectopic pregnancy. It complicates approximately 1 in 2200 pregnancies. However, it is becoming increasingly more frequent with the increasing number of caesarean sections performed each year. The recommended approach to treatment is therapeutic termination of pregnancy at the time of recognition. In this article, we present a case of caesarean scar pregnancy managed expectantly with Methotrexate and uterine Artery Embolization. We reported a case of 30 years old female, gravida 5, para1, live 1, abortion 3 with a previous history of caesarean section with GA of 8w5d/DCDA twin was admitted in view of low implantation of gestational sacs in lower uterine corpus. Trans vaginal ultrasound done and diagnosis of caesarean scar twin pregnancy was made. She was treated with Methotrexate 50 mg intramuscularly along with uterine artery embolization and follow up with beta HCG levels. Post embolization sac size was reduced and falling level of beta HCG values. Patient was discharged and follow-up with beta HCG level weekly. It is important for obstetrician and radiologist managing women with risk factor for a scar ectopic pregnancy to maintain a high index of suspicion during follow up. Failure to diagnose and initiate prompt management may lead to uterine rupture, massive Haemorrhage and maternal death