Background: Cesarean scar pregnancy (CSP) is the implantation of the gestational sac in
the hysterotomy scar. The optimal treatment for a cesarean scar pregnancy is unclear and therapy
should be selected according to the patients' clinical presentation. The aim of this study was to report
a successful medical treatment of a cesarean scar pregnancy with fetal heart activity and a very
high level of beta-human chorionic gonadotropin (β-hCG).
Case Presentation: A 38-year-old woman referred for a routine prenatal visit after 2 months of
menstrual retard and a positive pregnancy test. She had a history of 3 cesarean sections and a uterine
curettage. Ultrasonography revealed cesarean scar ectopic pregnancy. The serum level of β-hCG
was 109063 mIU/ml. Two doses of systemic methotrexate therapy and intragestational sac injection
of methotrexate and potassium chloride were administered. Eight weeks after the initial treatment,
the β-hCG level became undetectable.
Conclusion: Combined medical treatment with local and systemic MTX administration may be a
successful treatment with low complications even in the presence of high serum β-hCG level.