Cesarean scar ectopic pregnancy management with simultaneous isthmocele repair

Caesarean scar ectopic pregnancy (CSEP) is a very rare form of ectopic pregnancy. If not diagnosed and treated accordingly it can lead to life-threatening complications. Hitherto there is no standardised treatment established because of the rarity and diversity of the disease. We present the case of a 35-year-old third gravida primi para with caesarean scar pregnancy in 7th week of gestation. Since the patient declined a Methotrexate treatment, we performed hysteroscopic and laparoscopic resection of the ectopic pregnancy in combination with repair of the isthmocele. Because human chorionic gonadotrophin (hCG)-level showed no proper decline three weeks after the initial surgery a second look hysteroscopy and laparoscopy were performed with laparoscopic injection of MTX around the uterine suture, resulting in a full decline of hCG-level. The ultrasound performed before discharge shows a well-adapted uterine scar. A pregnancy can be aspired six-month post-surgery.