Background: An ectopic pregnancy developing in a Caesarean section scar is extremely rare. This type of ectopic pregnancy carries with it a high risk of morbidity related to uterine rupture and extensive hemorrhage. Conservative treatment in the form of local or systemic injection of methotrexate or local injection of potassium chloride is preferable to surgical management, as the former is fertility sparing.
Case: A 36-year-old multigravid woman was found to have an ectopic pregnancy in a Caesarean scar at seven weeks' gestation with a significantly elevated beta-human chorionic gonadotrophin (Beta-hCG) level. Systemic methotrexate therapy was unsuccessful; subsequently, a local injection of methotrexate was used with resolution of the pregnancy.
Conclusion: An ectopic pregnancy in a Caesarean scar can be managed effectively with local injection of methotrexate.