When Methotrexate Is Not Enough: Hysteroscopic Management of an Angular Pregnancy With Discordant Beta-Human Chorionic Gonadotropin (b-hCG) and Ultrasound Findings

An angular pregnancy is a rare form of ectopic implantation. We report a 30-year-old primigravida presenting with an abnormal beta-human chorionic gonadotropin (b-hCG) trend. At presentation, her b-hCG was 1,950 mIU/mL. Ultrasound showed an angular gestational sac with increased vascularization and deep myometrial extension. Methotrexate was administered, achieving biochemical response but with persistent suspicious ultrasound findings, suggesting ongoing trophoblastic activity. Due to this discordance, hysteroscopic management was performed. The gestational tissue was exposed and removed using a bipolar mini-resectoscope under direct visualization. The patient was discharged the same day. Hysteroscopy may represent a safe and effective option in selected cases with discordant biochemical and imaging findings.