Successful management of a spontaneous viable monochorionic diamniotic twin pregnancy on cesarean scar with systemic methotrexate

Abstract

Rationale:Cesarean scar twin pregnancy is exceedingly rare and it remains to be a life-threatening condition even in the early weeks of gestation. Because of its rare occurrence, there is no consensus on the treatment modality of cesarean ectopic pregnancy.Patient concerns:A 41-year-old, woman, gravida 7, para 6, with a history of low transverse cesarean section 2 years back presented with an estimated 6 weeks gestational age and viable spontaneous twin, monochorionic diamniotic gestation. The patient presented to the Emergency Department with complaints of vaginal bleeding and mild lower abdominal pain for 5 days.Diagnoses:An ultrasound examination was performed demonstrating a single intrauterine gestational sac with 2 viable embryos (monochorionic diamniotic) implanted in the lower uterine segment at the level of the prior cesarean section scar. A diagnosis of viable cesarean scar twin pregnancy was made.Interventions:A 2 doses of 50 mg/m2 methotrexate (MTX) was given intramuscularly. The response to the treatment was monitored by serial beta-human chorionic gonadotropin (β-hCG) and ultrasound.Outcomes:Patient was followed up with β-hCG weekly levels which became 0 after 68 days of treatment. During the follow-up, the patient was asymptomatic, no side effects of MTX were noticed.Lessons:We reported a rare case of viable monochorionic diamniotic twin pregnancy on a cesarean scar that was successfully treated with systemic MTX without any additional therapy. Additionally, the decline of β-hCG in twin ectopic cesarean scar pregnancy appears to be similar to a singleton ectopic pregnancy.

Elective embryo or fetal reduction for caesarean scar pregnancy combined with intrauterine pregnancy

“…One study used a local methotrexate injection as a treatment [28]. The biggest risk may be the side effects of the drug, including abnormal embryonic development [28,33]. This study did not detect any obvious intrauterine fetal abnormalities.…”

Live Cesarean Scar Pregnancy: A Case Report

“…However, because of difficult diagnoses, the misdiagnosis rate of CSP at first consultation is as high as 76% [10]. It can cause uterine or unmanageable bleeding if it is not treated in a time or in an improper way like curettage, sometimes making hysterectomy a must to control the life threatening haemorrhage resulting in loss of reproductive function [6,10].…”

Cesarean scar pregnancy treatment: a case series

“…The authors declare that they have no competing interests Author details 1 Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran. 2…”

“…Cesarean scar pregnancy (CSP) is a complicated and potentially life-threatening type of ectopic pregnancy. It is estimated that CSP comprises 0.04-0.05% of all pregnancies [1,2]. With the increased number of cesarean deliveries and the widespread use of ultrasound (US) in early pregnancy, the incidence of CSP is increasing [2].…”

“…It is estimated that CSP comprises 0.04-0.05% of all pregnancies [1,2]. With the increased number of cesarean deliveries and the widespread use of ultrasound (US) in early pregnancy, the incidence of CSP is increasing [2]. Two types of CSP have been defined.…”