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Case Report
 
Management of an 11-week cesarean scar pregnancy
Sara Rocha1, Ana Carocha1, Catarina Marques1, Ana Gonçalves Andrade1, Álvaro Cohen1, Carlos Barros1
1Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa - Centro Hospitalar Lisboa Central, Lisbon, Portugal.

Article ID: 100004Z08SR2015
doi:10.5348/Z08-2015-4-CR-4

Address correspondence to:
Sara Rocha
Rua Viriato, n°1, Lisboa
Portugal, Postal Code: 1069-089
Phone: +351213184000
Fax: 213184029

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How to cite this article:
Rocha S, Carocha A, Marques C, Andrade AG, Cohen Á, Barros C. Management of an 11-week cesarean scar pregnancy. J Case Rep Images Gynecol Obstet 2015;1:10–14.


Abstract
Introduction: Cesarean scar pregnancy is a life-threatening condition, especially in the advanced gestational age. Optimal management has not yet been established because this is a rare condition.
Case Report: A 30-year-old female, with a previous cesarean, diagnosed with a viable cesarean scar pregnancy with 11 weeks of gestation. Successful termination of cesarean scar pregnancy was achieved with systemic and local (ultrasound-guided) methotrexate administration with subsequent dilatation and evacuation, under ultrasound guidance, in a two- stage procedure: rupture of the amniotic sac with partial removal of the fetus and one week later total evacuation of uterine content, with satisfactory hemostasis.
Conclusion: Cesarean scar pregnancy is associated with a high morbidity and adverse consequences for future fertility. There is no optimal management established, because of the rarity of the condition. We present a case of successful termination of an advanced first trimester cesarean scar pregnancy.

Keywords: Cesarean scar pregnancy, Intracardiac methotrexate injection, Uterine evacuation


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Author Contributions
Sara Rocha – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Ana Carocha – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Catarina Marques – Acquisition of data, Analysis and interpretation of data, Drafting the article, Final approval of the version to be published
Ana Gonçalves Andrade – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Álvaro Cohen – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Carlos Barros – Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Sara Rocha et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.