Transvaginal sono-guided aspiration of gestational sac concurrent with a local methotrexate injection for the treatment of unruptured cesarean scar pregnancy

Purpose: Cesarean scar pregnancy (CSP) is one of the rarest forms of ectopic pregnancy. A delay in treatment can lead to massive bleeding, uterine rupture, and life-threatening maternal morbidity. We present a conservative method for the management of CSP at a single tertiary centre over a 6-year period. Methods: Eleven patients with unruptured CSPs who were treated by transvaginal aspiration of the gestational sac followed by a local methotrexate injection were evaluated. Results: Gestational age at diagnosis ranged from 5 + 2 weeks to 7 + 4 weeks. Seven of the patients had undergone two prior Caesarean sections (63.6 %). The levels of β-hCG at the time of diagnosis ranged from 1,290 to 81,586 mIu/ml. The mean time of the procedure was 8.2 ± 1.6 min. During follow up, 54.5 % of the patients may need an additional systemic MTX injection due to an elevation of β-hCG. Estimated blood loss of the procedure was 20,000 mIU/ml at diagnosis.