TWO-DOSE METHOTREXATE REGIMEN FOR TREATMENT OF CESAREAN SECTION SCAR PREGNANCY

Abstract

Cesarean section scar pregnancy (CSSP) at 5 weeks+2days and initial β-hCG 4361 mIU/ml was diagnosed in a 44-year-old patient (previous 3 vaginal deliveries and one cesarean section) by trans-vaginal ultrasound (TVS). She refused methotrexate (MTX) treatment at the beginning, and she decided to repeat β-hCG after two days, which came as 5378 mIU/ml. She agreed for MTX treatment later, after she noticed the rising β-hCG titer. The repeated β-hCG was 6758 and 6132 mIU/ml on the 4th and 7th day; respectively following first MTX-dose, therefore, she was given the second MTX-dose. The β-hCG decreased from 6132 mIU/ml to 4335 mIU/ml on the 4th day following the second MTX-dose (>15% drop of β-hCG). Follow-up β-hCG showed gradual drop from 2736 mIU/ml on 7th day following second MTX-dose, to 682.8 mIU/ml on 2nd week following second MTX-dose, then to 20.2, and 83.1 mIU/ml on 3rd and 4th week; respectively following second MTX dose. Furthermore, β-hCG dropped to 35.6 and 15.26 mIU/ml on 5th and 6th week; respectively following second MTX-dose and returned to non-pregnant level 4.07 mIU/ml on the 8th week following second MTX-dose. This report represents variant of CSSP successfully treated with two-dose MTX regimen with no side effects and/or complications. This report suggests the two-dose MTX regimen for treatment of CSSP diagnosed at 5-6 weeks, with no viable fetus, and initial β-hCG between 5500-6000 mIU/ml.