Cervico-Isthmic Pregnancy on Cesarean Scar Successful Treated with Methotrexate, Mifepristone and Misoprostol: A Case Report

Abstract

Introduction: Cervico-isthmic pregnancy is rare, and serious because of its hemorrhagic complication. Its management varies according to the teams. Observation: We report a case of cervico-isthmic pregnancy on a cesarean scar. This is a 35-year-old, G2P2, who consulted for bleeding from the 1st trimester of pregnancy. The clinical examination found a minimal uterine bleeding. The diagnosis was made by a vaginal ultrasound which found a cervico-isthmic implantation of the pregnancy on the caesarean scar. A protocol of Mifepristone and Misoprostol followed by administration of a single dose of 1 mg/kg of Methotrexate was performed. Cure was obtained 1 month after treatment by negativation of plasma HCG. No bleeding complications were noted. A follow-up ultrasound performed 2 months later showed a uterine vacuity and the presence of an isthmocoele. It was in fact a pregnancy that had implanted in the isthmocoele. Conclusion: Cervico-isthmic pregnancy is rare. His treatment is not codified. Drug management was successful.