Heterotopic Cesarean Scar Pregnancy in a Spontaneous Cycle

Chin-Jung Wang, MD, Yao-Lung Chang, MD, Hsing-Tse Yu, MD, Pei-Ju Wu, MD, Shang-Gwo Horng, MD, Chia-Chang Tsai, MD

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan (Drs. Wang, Chang, Yu). Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University of Medicine, Tao-Yuan, Taiwan (Dr. Wang). Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan (Dr. Wu). Department of Obstetrics and Gynecology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan (Dr. Horng). Tsai’s Women and Children Clinics, New Taipei, Taiwan (Dr. Tsai).


Introduction: We report a viable cesarean scar pregnancy with a coexistent intrauterine pregnancy, managed successfully with operative hysteroscopy and suction curettage.

Case Description: A 32-year-old woman, with previous cesarean delivery, presented with vaginal bleeding and was referred to our hospital at 9 weeks’ gestation for heterotopic pregnancy in a spontaneous cycle. An intrauterine pregnancy combined with a cesarean scar pregnancy was shown by ultrasonography. The patient underwent hysteroscopy-directed evacuation of the cesarean scar pregnancy and suction curettage with good hemostasis.

Discussion: Spontaneous heterotopic cesarean scar pregnancy is a rare but possible entity. The combination of hysteroscopy and suction curettage is an option for a minimally invasive procedure for heterotopic cesarean scar pregnancy.

Key Words: Cesarean scar, Heterotopic, Hysteroscopy, Pregnancy.

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