Introduction: The overall incidence of Cesarean scar pregnancy is increasing due to Cesarean rates. This
life-threatening condition has been historically managed in various ways as no single modality is reliable
enough. We report this case of live CSP managed initially with Fetocide followed by Methotrexate but
requiring Surgical management later on.
Presentation: A 32 years old para 5 with four previous Cesarean sections was diagnosed with live CSP.
HCG level was 76,619. The initial management was fetocide with KCL followed by Methotrexate. The
treatment was considered successful in view of appropriate reduction in serum HCG levels. The woman
required surgical management 10 weeks after the initial management, but the blood loss was minimal.
Discussion: A CSP may be asymptomatic or present with non-specific symptoms. The rate of initial
misdiagnosis is as high as 76%. TVUSS enables correct CSP diagnosis and implementation of minimally
invasive effective treatment. HCG levels can affect the overall outcome, but medical management can be
considered even with high HCG levels.
Conclusion: CSP is a life-threatening condition, therefore timely diagnosis and appropriate management is
crucial. Medical management can be considered in most cases even with high HCG, but management has
to be tailored according to the patient. Close follow up of patient after Medical treatment is important as
they may require further intervention.
Ruptured Cesarean Scar Pregnancy: A Case Report
