Cesarean section scar pregnancy

Introduction
Cesarean section scar pregnancy (CSSP) occurs due to implantation of the gestational sac over the previous cesarean section or hysterotomy scars.

Case description
A 40-year-old woman referred to our hospital with a missed period for 5 weeks +3 days, mild vaginal spotting and β-hCG 5770 mIU/ml as a case of ectopic pregnancy. The repeated β-hCG was 8797 mIU/ml and the transvaginal ultrasound (TVS) showed the gestational sac located in the lower anterior quadrant of the uterus behind the urinary bladder (only a thin layer of myometrium separating it from the bladder), close to the internal cervical os and the site of the previous scars. The case was diagnosed as CSSP and managed according to the hospital protocol by systemic multi-dose methotrexate (MTX) with follow-up using β-hCG, TVS and complete blood count (CBC). When the β-hCG result was found to be 60.66 mIU/ml, and the repeated weekly TVS showed a progressive decrease in the size of the gestational sac, the studied woman was discharged from the hospital for follow-up in the outpatient department (OPD).

Conclusions
There is no single best treatment to terminate the CSSP, and the procedure with the fewest complications should be selected. Several authors support systemic multi-dose MTX treatment for CSSP with follow-up using TVS, β-hCG and CBC.