LSCS scar ectopic pregnancy - Novel management experience

Jayprakash Shah, MD

Rajni Hospital, Fetal Medicine Center, Ahmedabad, india.

Case report

A woman 33 year-old, G3-P2 with one lower segment cesarean section (LSCS), otherwise with unremarkable history came to our institution for early pregnancy scan. Urine pregnancy test was positive. 

Our ultrasound examination confirmed intrauterine pregnancy. Transvaginal ultrasound shows LSCS scar ectopic pregnancy at 7 weeks 4 days of gestation. Trophoblast was almost reaching the serosa. hGC Beta subunit was 18.500. 

Due to risk of excessive bleeding and perforation through scar medical management was decided. With the consent of the patient medical management of scar ectopic pregnancy was initiated. Two doses of methotraxate 1 mg per kg body was given on alternate days.

On 4th day, live scar ectopic  was noted with regular cardiac activity. Selective fetal reduction by abdominal route was decided.

Two doses of mifepristone was given on alternate days. On 10th day after procedure scar ecopic was reviewed, Only a small clot-like echogenic area was visible. hGC Beta subunit 1786 units.
Repeat evaluation after 10 days revealed an echogenic scar only.

This case explains how the combined use of methotrexate with selective reduction along with mifepristone can help in medical management of ectopic pregnancy with high levels of hGC Beta subunits and cardiac activity.

More studies are required to validate this management and technique.

Images 1-5: 2D and doppler images show lower segment cesarean section ectopic pregnancy with trophoblastic tissue in contact with the scar and normal cardiac activity.

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Videos 1, 2: 2D and doppler images show increased vascularization in the trophoblastic area and fetal reduction procedure.

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