The management of Cesarean scar ectopic pregnancy following treatment with methotrexate—a clinical challenge

• DOI: 10.1002/uog.5149
• Publication Date: 2007-10-02T15:16:24Z
• Authors: S. Deb; J. Clewes; C. Hewer; N. Raine‐Fenning
• Keywords: Human chorionic gonadotropin; Trophoblast

Abstract We present a case of Cesarean scar ectopic pregnancy, complicated by the persistence clinical symptoms despite rapid and complete biochemical response to single systemic injection methotrexate. A 34‐year‐old woman with three previous sections was diagnosed pregnancy following @ in‐vitro fertilization treatment. The diagnosis suggested three‐dimensional (3D) ultrasound scan confirmed magnetic resonance imaging (MRI). Management involved administration methotrexate follow‐up serial assessments serum beta‐human chorionic gonadotropin (β‐hCG) measurements. main challenge adequate medical treatment, as judged resolution trophoblastic activity, which resulted in repeated admissions hospital. Serial transvaginal scans showed an initial increase size mass, led increasing anxiety couple. Eventually, 15 weeks after methotrexate, couple requested surgical intervention. An uneventful resection abnormal area, appearances suggestive tissue, undertaken good effect. In summary, normalization β‐hCG patient remained symptomatic had incomplete resorption trophoblast, necessitating Copyright © 2007 ISUOG. Published John Wiley & Sons, Ltd.