Dr. Lerner is Associate Clinical Professor in Maternal-Fetal Medicine and Director of Ultrasound, Columbia University Medical Center, New York, New York.
Dr. Horvath is PGY-4 Resident, Department of Obstetrics and Gynecology, Columbia University Medical Center.
Dr. Simpson is Minimally Invasive Surgery Fellow, Department of Obstetrics and Gynecology, Columbia University Medical Center.
Dr. Advincula is the Levine Family Professor of Women’s Health and Vice-Chair, Department of Obstetrics & Gynecology and Chief of Gynecology, Sloane Hospital for Women at Columbia University Medical Center, New York, New York.
Dr. Advincula reports being a consultant to Blue Endo, CooperSurgical, Intuitive Surgical, SurgiQuest, and Titan Medical and receiving royalties from CooperSurgical. The other authors report no financial relationships relevant to this article.
The presentation of a cesarean scar ectopic pregnancy can at times be daunting, especially without familiarity regarding its management. Women with cesarean scar ectopic pregnancy most often have no symptoms, although vaginal bleeding and abdominal pain can present. Upon visual diagnosis with transabdominal or transvaginal ultrasound, the preferred treatment method is direct injection of methotrexate into the gestational sac within the cesarean scar.
In this video, my colleagues review the indications and contraindications for direct injection of methotrexate as well as alternative treatment methods for this type of nonviable pregnancy that is increasing in frequency (given the US cesarean delivery rate). Demonstrated is the technique for methotrexate injection in the case of a 34-year-old woman (G6P0232) with ultrasound and beta−human chorionic gonadotropin confirmation of cesarean scar ectopic pregnancy.
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