Conservative Management of Live Caesarean Scar Ectopic Pregnancy by Ultrasound Guided Intrasacular Injection of KCL and Methotrexate

Abstract Caesarean scar pregnancy is a potentially dangerous consequence of a previous caesarean delivery1.it is complex pathological condition and occasionally can be life threatening due to complications. It’s a rarest form of ectopic pregnancy with high morbidity and mortality2. Aim and objective: To describe our experience of successful management of live caesarean scar ectopic pregnancy with transvaginal ultrasound guided intrasaccular injection of KCL followed by methotrexate4. A 33 yr old G6P2L2MTP1A2 presented at 5weeks 3 days of gestational age with beta HCG if 16676 IU/ml with live caesarean scar ectopic pregnancy on transvaginal ultrasonography, patient was vitally stable. Decision on choice of treatment was mainly by period of gestation, clinical symptoms and initial serum bets HCG levels. Treatment options were given to patient among conservative management using medical methods, minimal invasive approach and surgical approach, however, patient opted for Minimally invasive management by Transvaginal ultrasound guided KCL was injected into fetal heart to achieve cardiac asystole, followed by injection of methotrexate in amniotic sac. Patient was monitored clinically, and on USG for loss of trophoblastic flow on Doppler examination and serial beta HCG level with initial rise and later steady decrease in serum beta HCG levels. Resolution of ectopic pregnancy was achieved over a period of 3 month and high-risk surgical intervention were avoided. Successful management of live caesarean scar ectopic pregnancy with transvaginal ultrasound guided intrasaccular injection of KCL followed by methotrexate.