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However, many hypotheses have been proposed and one of them is that the conceptus enters into the myometrium through a microscopic tract between the prior caesarean scar and the endometrial canal.
Early detection and treatment is necessary to avoid complications like uterine rupture, maternal mortality or adverse impacts on future fertility due to hysterectomy.
One week after this procedure, serum β HCG dropped to 6691 m IU/ml and TVS showed residual products of conception in the previous sac site.
Serum β HCG continued to show falling trend and normalized on day 84th (12 weeks) following treatment and TVS showed an empty endometrial cavity.
She was treated with intracardiac potassium chloride, and intragestational sac and placental Methotrexate injection.
Injection Methotrexate 25 mg was instilled into the amniotic sac and placenta each.Her obstetric history included a full term uneventful caesarean section 12 years back and a spontaneous abortion 3 years back at 1½ months amenorrhea not followed by evacuation.On admission, her general physical and systemic examination was normal.Conclusion: Diagnosis of caesarean scar pregnancy is difficult, but transvaginal sonography and colour flow Doppler may be helpful.Though the best and standard management is still unclear for this condition, the use of intracardiac KCl, and intra sac and placental Methotrexate can be considered in cases of viable caesarean scar pregnancy.
Diagnosis is difficult but transvaginal sonography and colour flow Doppler using the following criteria may be helpful.