A case of caesarean section scar pregnancy after an intra uterine contraceptive device insertion managed by methotrexate injection and hysteroscopic removal of the intra uterine contraceptive device and the collapsed gestational sac

Abstract EN

Caesarean section scar pregnancy (CSP), is a form of ectopic pregnancy where the gestational sac is embedded in the site of the previous caesarean section scar.

It is considered a potentially dangerous condition as it may cause life-threatening bleeding or if it persists, it may lead to increasing morbidity and even mortality from a pathologically adherent placenta.

the treatment of CSP may vary based on each individual case.

however, early diagnosis using high index of suspicion in selected cases and early management of each of these cases are of the utmost importance to prevent potential complications.

we present a case of early diagnosed CSP conceived shorty after insertion of an intrauterine contraceptive copper device (IUCD), just four months following the patient’s 5th caesarean section.

the case was managed by systemic methotrexate outside our institution; however, the pregnancy and the device were not expelled and remained attached to the scar for another six weeks, causing the patient pain and ongoing bleeding.

hysteroscopy was done in our institution with removal of both the gestational sac and the IUCD.

No further procedure was needed and follow up of the patient was uneventful.

this case report seeks to highlight that the management of CSP often requires individualization as per the unique condition of the patient herself.

consecutive intervention was needed for our patient to achieve full treatment, indicating that the management of CSP is a condition where a multidisciplinary approach might be needed.