Successful conservative management of a high-level β-hcg cesarean pregnancy

Herbert Situmorang, Duma Margaretha

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


Cesarean scar pregnancy (CSP) is a serious condition in which the embryo implants within the myometrium of a previous cesarean section scar. A standard treatment protocol for this condition has not yet been established as the data remain limited, given the rarity of its occurrence. This case report describes a patient who was diagnosed with a CSP at 12 weeks of gestation with beta-human chorionic gonadotropin (β-hcG) levels of 34,968.12 mIU/mL. She was successfully treated with systemic methotrexate followed by evacuation through a hysteroscopic procedure using an Integrated Bigatti Shaver. This report adds to the literature on safe and effective treatments for CSP. A 35-year-old, gravida 4, para 3, woman with a history of two prior term cesarean sections was diagnosed with a CSP during a routine first-trimester ultrasound at 12 weeks of gestation. She had reported spotting in the previous 2 weeks. Ultrasound revealed a gestational sac with a diameter of 2.62 cm. Methotrexate 50 mg/m2 was administered as a single dose via intravenous infusion according to the “two-dose regimen,” following which β-hcG levels decreased. The present case is an important contribution to the research on CSP treatment. Systemic methotrexate followed by a hysteroscopic procedure is a safe and effective approach for conservative treatment of a first-trimester CSP while preserving fertility.

Original languageEnglish
Title of host publicationObstetric and Gynecology Case Report
PublisherNova Science Publishers, Inc.
Number of pages9
ISBN (Electronic)9781536167122
ISBN (Print)9781536167115
Publication statusPublished - 1 Jan 2020


  • Cesarean section scar pregnancy
  • Ectopic pregnancy
  • Methotrexate


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