Medical Treatment in Cesarean Scar Pregnancy with Fetal Heart Activity and High Level of Serum β-hCG: A Case Report

Background: Cesarean scar pregnancy (CSP) is the implantation of the gestational sac in the hysterotomy scar. The optimal treatment for a cesarean scar pregnancy is unclear and therapy should be selected according to the patients' clinical presentation. The aim of this study was to report a successful medical treatment of a cesarean scar pregnancy with fetal heart activity and a very high level of beta-human chorionic gonadotropin (β-hCG). Case Presentation: A 38-year-old woman referred for a routine prenatal visit after 2 months of menstrual retard and a positive pregnancy test. She had a history of 3 cesarean sections and a uterine curettage. Ultrasonography revealed cesarean scar ectopic pregnancy. The serum level of β-hCG was 109063 mIU/ml. Two doses of systemic methotrexate therapy and intragestational sac injection of methotrexate and potassium chloride were administered. Eight weeks after the initial treatment, the β-hCG level became undetectable. Conclusion: Combined medical treatment with local and systemic MTX administration may be a successful treatment with low complications even in the presence of high serum β-hCG level.