The pregnancy dating dilemma
On per vaginal examination, uterus was 8 weeks size, anteverted, soft, mobile and bilateral fornices were free and non-tender. A diagnosis of caesarean scar pregnancy was made on the basis of TVS showing- 1) Gestational sac of 3.3 × 3.8 × 3.2 cm corresponding to 10 2 weeks gestation with cardiac activity in the lower uterine segment at the site of previous caesarean scar (Figure 1), Figure 1: (A) Transabdominal ultrasound showing a gestational sac in the lower uterine cavity adjacent to the previous scar with thinning of anterior myometrium.(B) Transvaginal scan with colour flow Doppler showing vascularity around the gestational sac.Scar pregnancy, Caesarean scar pregnancy, Intracardiac KCl, Methotrexate.
• Visualization of an empty uterine cavity as well as an empty endocervical canal • Detection of the placenta and/or a gestational sac embedded in the hysterotomy scar • A thin or absent myometrial layer between the gestational sac and the bladder • A closed and empty cervical canal • The presence of embryonic or fetal pole or yolk sac with or without cardiac activity • The presence of prominent or rich vascular pattern in the area of caesarean scar.She was treated with intracardiac potassium chloride, and intragestational sac and placental Methotrexate injection.She was followed up and at 12 weeks post treatment serum β HCG normalized and endometrial cavity was empty on transvaginal sonography.However, conservative treatments have been tried to preserve future fertility like local and systemic Methotrexate injection.In a case reported by Tulpin et al., local methotrexate injection was followed by uterine artery embolization to successfully treat a caesarean scar pregnancy. reported another case wherein they successfully treated a caesarean scar pregnancy at 9 3 weeks with bilateral uterine artery embolization followed by local injection of KCl and Methotrexate under sonographic guidance.