Hysteroscopic treatment for a cesarean scar pregnancy

Cesarean scar pregnancy (CSP) is a comparatively rare clinical condition, but it is complicated by hemorrhage that is often difficult to achieve hemostasis following detachment or removal of the products of conception. Our aim was to preserve the uterus in a CSP, and after the systemic administration of methotrexate (MTX), removal of the conceptus with a hysteroscope was attempted.A 35-year-old woman was referred to our hospital from another institute with a diagnosis of a cervical pregnancy CSP was diagnosed by transvaginal ultrasonography, and the serum hCG value was 37, 376 mIU/ml with a positive fetal heart beat. The serum hCG value declined gradually thereafter, although it temporarily rose to 79, 914 mIU/ml after the systemic administration of MTX. There were no symptoms, such as hemorrhage, and at the point when the serum hCG value had dropped to 2303 mIU/ml, we performed a hysteroscopic resection.Treatment of CSP by hysteroscopy has the advantage of direct visualization of the implantation site. Hysteroscopic resection is a useful technique in selective cases.