Conservative Management of Cesarean Scar Ectopic Pregnancy with Fetal Heart Activity and a Very High β-hCG

Case Reports in Obstetrics and Gynecology
Rodney McLarenMohamad Irani

Abstract

Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP with β-hCG higher than 62,000 IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitative β-hCG of 144,337 IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Her β-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very high β-hCG and fetal heart activity can be offered conservative or fertility preserving management.

References

Feb 1, 1997·Fertility and Sterility·P A GodinJ Donnez
Apr 1, 2003·Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology·D JurkovicC J Elson
Jun 9, 2005·The Tohoku Journal of Experimental Medicine·Junichi SugawaraKunihiro Okamura
Jun 2, 2006·Obstetrics and Gynecology·Michael A RotasMichael Levgur
Jun 12, 2010·BJOG : an International Journal of Obstetrics and Gynaecology·X-Y YangA Zheng
Sep 13, 2014·International Journal of Gynaecology and Obstetrics : the Official Organ of the International Federation of Gynaecology and Obstetrics·LvFen GaoXiaoyu Wang
Oct 10, 2014·European Journal of Obstetrics, Gynecology, and Reproductive Biology·Haim KrissiYoav Peled

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Methods Mentioned

BETA
cesarean section
cesarean sections
hysterectomy

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