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Case Reports in Obstetrics and Gynecology
Volume 2017 (2017), Article ID 9536869, 4 pages
https://doi.org/10.1155/2017/9536869
Case Report

Recurrent Cesarean Scar Ectopic Pregnancy Treated with Systemic Methotrexate

1Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
2Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA

Correspondence should be addressed to Chima Ndubizu; moc.liamg@uzibudnc

Received 22 August 2017; Accepted 5 November 2017; Published 23 November 2017

Academic Editor: Giovanni Monni

Copyright © 2017 Chima Ndubizu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cesarean scar pregnancy (CSP) is a rare event; however its incidence has been rising due to the increasing rates of cesarean deliveries. The majority of cases present with signs or symptoms requiring surgery, which often results in hysterectomy. The recurrence of CSP is even rarer with only few cases which have been reported. This is a report of recurrent cesarean scar ectopic pregnancy (RCSP) that was promptly diagnosed and managed with only systemic methotrexate. This was a 30-year-old woman, with a history of two prior cesarean deliveries followed by a CSP, who presented at 5 weeks and 3 days of gestation for her first prenatal visit. Transvaginal ultrasound revealed a RCSP. Her serum beta-human chorionic gonadotropin (β-hCG) level was 54,295 IU/L. The first CSP, which was diagnosed at a later stage, was treated with uterine artery embolization and systemic methotrexate leading to complete resolution within 10 weeks. The current ectopic was treated with two doses of systemic methotrexate; her serum β-hCG reached undetectable levels within 7 weeks. Thus, patients with a history of prior CSP should be carefully monitored with transvaginal ultrasound during subsequent pregnancies to allow early diagnosis of RCSP, which could then be treated conservatively.