Hysteroscopically guided subchorionic methotrexate administr
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Cesarean scar pregnancy (CSP) is a rare but life-threatening condition, due to the risk of uterine rupture or for the development of placenta previa/accreta. The mainstay of management to spare fertility is early diagnosis and pregnancy termination. Although several conservative treatments have been experienced, no consensus on the best therapeutic approach is currently shared. The medical therapy for CSP termination is based on systemic or local Methotrexate (MTX) administration.A 36-year-old female with a history of cesarean section was admitted to our department with a diagnosis of viable 7th weeks CSP. The patient gave her consent to pregnancy termination by a hysteroscopically-guided MTX administration within the cervico-isthmic placental implantation site, followed by its resectoscopic removal. In an office setting, 80 mg of MTX were injected through a needle adaptable to the 5-Fr operative channel of hysteroscope, under the chorionic membrane of placental implantation site.An early embryo demise was obtained; the human chorionic gonadotropin-beta subunit (beta-hCG) serum trend showed a rapid pregnancy termination and no patient complaints were recorded. After 28 days, a resectoscopic removal of the gestational sac and placenta was safely accomplished....

http://www.edoriumjournals.com/journal-of-case-reports-and-images-in-obstetrics-and-gynecology/archive/2016-archive/100008Z08GG2016-garuti/100008Z08GG2016-garuti-full-text.php
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