Cesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy that is growing in incidence. The diagnosis of most CSP occurs when patients present in unstable conditions requiring surgical management and leading sometimes to hysterectomy. It has been shown that medical management is a safe option for early diagnosed hemodynamically stable CSP. However, no cases of CSP withβ-hCG higher than 62,000 IU/L, conservatively treated, have been reported. We report the case of a 29-year-old patient who presented for her first prenatal visit at 13-week gestation and was diagnosed with CSP with present fetal heart tones and a quantitativeβ-hCG of 144,337 IU/L. She was treated with bilateral uterine artery embolization and systemic methotrexate. Herβ-hCG significantly decreased and became undetectable within 10 weeks. We propose that patients with CSP with very highβ-hCG and fetal heart activity can be offered conservative or fertility preserving management.
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机译：剖宫产疤痕异位妊娠（CSP）是一种罕见的异位妊娠，其发病率正在增加。大多数CSP的诊断发生在患者处于不稳定状态，需要进行手术管理并有时导致子宫切除术时。已经表明，对于早期诊断的血液动力学稳定的CSP，医疗管理是一种安全的选择。然而，没有报道保守治疗过β-hCG高于62,000 IU / L的CSP病例。我们报告了一名29岁患者的情况，该患者在妊娠13周时首次进行产前检查，并被诊断为CSP，目前有胎儿心音，定量β-hCG为144,337 IU / L。她接受了双侧子宫动脉栓塞术和全身氨甲蝶呤治疗。 Herβ-hCG显着下降，并在10周内无法检测到。我们建议可以为患有CSP且β-hCG很高且胎儿心脏活动很高的患者提供保守或生育保护管理。
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