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Background . Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially when  β -subunit human chorionic gonadotropin ( β -hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment.  Methods . Under intravenous anesthesia, six CSPs including a case with  β -hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly if  β -hCG levels stayed beyond the expected values.  Outcomes . All cases achieved  β -hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment.  Conclusion . Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this.

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only