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Chima Ndubizu [1] and Rodney A. McLaren Jr. [1] and Sandra McCalla [1] and Mohamad Irani [2]

Academic Editor: Giovanni Monni

1, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA, maimonidesmed.org

2, Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY 10021, USA, cornell.edu

Received Aug 22, 2017; Accepted Nov 5, 2017

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1. Introduction

Cesarean scar pregnancy (CSP) remains a rare condition despite its increased incidence over the last two decades, which has been attributed to increased cesarean section rates and frequent use of transvaginal ultrasound in the first trimester [1]. CSP represents 6% of all ectopic pregnancies in women with at least one prior cesarean delivery [2, 3]. There are several reported cases of CSP that were managed expectantly and reached successful deliveries, mostly requiring cesarean hysterectomy [4]. Late diagnosis of CSP can be associated with devastating sequelae such as uterine rupture, hemorrhage, need for hysterectomy, and maternal death. The outcome is thus dependent on the timing of diagnosis and type of intervention.

The incidence of recurrent CSP (RCSP) is unknown but it is estimated to be much rarer than CSP [5, 6]. The reported cases were managed surgically (ultrasound-guided suction and evacuation), intragestational sac methotrexate injection, or combination of systemic methotrexate with intragestational sac injection of methotrexate and potassium chloride (KCL) [5, 7, 8]. This is a report of RCSP that was successfully treated with only systemic methotrexate.

2. Case Report

A 30-year-old woman G5P2113 (2 term deliveries, 1 preterm delivery, 1 CSP, and 3 living children) presented for prenatal care at 5 weeks and 3 days of gestation. The patient was asymptomatic at the time. She had a history of vaginal delivery followed by two cesarean deliveries then a CSP. The first cesarean section was performed at 31 weeks of gestation owing to the occurrence of vaginal bleeding in the setting of placenta previa. The patient underwent a second cesarean section after failing trial of labor. Her previous CSP was diagnosed at 13 weeks of gestation with β-hCG of 144,337 IU/L....

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