Caesarean scar pregnancy in a 32-year-old woman: initial double-dose methotrexate followed by laparotomy and myometrial reconstruction

ABSTRACT

Introduction. Caesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy associated with a high risk of uterine rupture and severe haemorrhage.

Case Presentation. A 32-year-old woman with one previous caesarean section presented at 7 weeks of amenorrhea with vaginal spotting and abdominal discomfort. Transvaginal ultrasound revealed a viable gestational sac implanted in the caesarean scar, with a residual myometrial thickness of 1 mm. Initial management with a double-dose systemic methotrexate protocol was unsuccessful. Due to persistence of trophoblastic activity and high risk of rupture, surgical treatment was performed. Laparotomy allowed complete excision of the gestational tissue and reconstruction of the uterine wall.

Conclusions. In selected high-risk CSP cases, particularly in the presence of extremely thin myometrium and failure of medical therapy, laparotomy with uterine reconstruction represents a safe and definitive treatment option that may preserve future fertility.

Key words

Caesarean scar pregnancy; myometrial thickness; methotrexate; laparotomy; surgical treatment.