Caesarean Scar Pregnancy Managed Noninvasively with Systemic Methotrexate

A higher rate of caeserean section in the past few decades has led to an increase in the incidence of caeserean scar pregnancy. It is a serious emergency and presents often with one or more near fatal bouts of uterine hemorrhage. Caeserean scar pregnancy is a rare type of ectopic pregnancy where the embryo implants in the myometrium of lower segment at the site of previous caesarean section scar. The possible mechanism of this condition is the penetration of the blastocyst through a micro tubular tract between the caesarean scar and endometrial canal and thereby implantation into the myometrium. The clinicians are still not aware of the presentation and frequently misdiagnose it as a case of incomplete abortion. In one report as the dilator was put for an attempt to suction and evacuation, patient bled profusely and went into shock and developed obstetric collapse [1].