Cesarean Scar Pregnancy Management: Minimally Invasive Suction of the Gestational Sac Content Combined With Local and Intramuscular Methotrexate Injection

Background: Cesarean scar pregnancy is a rare, potentially life-threatening complication in patients with prior cesarean delivery. Vaginal bleeding is a common presenting symptom. Case Report: A 23-year-old female who presented with mild vaginal bleeding was diagnosed by transvaginal ultrasound with a viable cesarean scar pregnancy of 7 weeks’ gestation. After the sac content was suctioned through a transvaginal approach under ultrasound guidance, the patient was injected with 50 mg local and 25 mg systemic methotrexate. One week later, a repeat systemic methotrexate dose of 50 mg was administered. The patient's beta human chorionic gonadotropin (hCG) levels were followed weekly until a negative beta hCG level was established. Conclusion: No management approach has been universally approved for cesarean scar pregnancy; the best option depends on case presentation, surgeon experience, and available facilities. We suggest that our minimally invasive treatment is an acceptable approach, especially if embryonic cardiac activity is present. We recommend the referral of such cases to tertiary centers to avoid complications.