Rare Case of Caesarean Scar Pregnancy with Soaring β-hCG Levels: A Therapeutic Challenge
Published: December 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58004.17300
Nishtha Jaiswal, Reena Yadav, Apurwa Bardhan, Manisha Kumar
1. Associate Professor, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, Delhi, India.
2. Director Professor and Head, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, Delhi, India.
3. Ex-Senior Resident, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, Delhi, India.
4. Director Professor, Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, Delhi, India.
Correspondence
Dr. Nishtha Jaiswal,
203, Type 4 LHMC Faculty Flats, New Delhi, Delhi, India.
E-mail: nishtha.amu@gmail.com
Caesarean Scar Pregnancy (CSP) is a life-threatening form of ectopic pregnancy characterised by abnormal implantation of embryo within the myometrium and fibrous tissues of a previous scar on the uterus. This is the case report of a 24-year-old pregnant lady who underwent previous caesarean section presented at eight weeks gestation with bleeding per-vaginum. Ultrasound of pelvis revealed an intrauterine gestational sac with a live foetus at the site of previous caesarean scar with very high levels of serum beta-human Chorionic Gonadotropin (β-hCG) of 88789 mIU/mL. To prevent surgical complications, a conservative approach was employed, involving injection methotrexate and uterine artery embolisation. Serial measurements of serum β-hCG and transvaginal sonography were used for monitoring. Treatment was successful and the β-hCG levels returned to normal on day 48. This case report highlights that conservative management is successful even with extremely high serum β-hCG levels, and an early recognition and timely intervention is the key to prevent poor outcomes.
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