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Gynecol Minim Invasive Ther. 2019 Oct 24;8(4):185-187. doi: 10.4103/GMIT.GMIT_134_18. eCollection 2019 Oct-Dec.

Successful Pregnancy Outcome Immediately after Methotrexate Treatment for Cesarean Section Scar Pregnancy.

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Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait.
Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.
Department of Normal and Topographical Anatomy, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.
Department of Obstetrics and Gynecology No. 1, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan.


A 27-year-old cesarean section scar pregnancy (CSSP) case diagnosed by the vaginal ultrasound which showed gestational sac located in the lower uterine anterior quadrant close to the site of the previous scars (with yolk sac inside) with β-hCG 15,373 mIU/ml in September 2017 was managed by intramuscular (IM) multidose methotrexate (MTX). The studied woman discharged home when the β-hCG decreased to 11,630 mIU/ml on the 1st week after the first MTX dose. On the 5th week after the first dose of IM-MTX, the β-hCG dropped to zero and the gestational sac completely disappeared. She was counseled about the risk of pregnancy in the first 6 months after the MTX and the possibility of the CSSP recurrence. She presented on December 16, 2018, with preterm delivery at 35 weeks' gestation. After delivery, her neonate admitted to the neonatal intensive care unit (NICU) due to mild respiratory distress and discharged from the NICU on the 4th day in good condition. Multi-dose MTX regimen for the treatment of CSSP supported by many authors with follow-up by β-hCG and vaginal ultrasound. This report highlights the successful outcome immediately after the proper management of CSSP cases.


Cesarean section scar pregnancy; methotrexate; pregnancy

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