Background: Cesarean Scar Pregnancy (CSP) is a cause of severe maternal
morbidity. Currently, no guideline for its management is shared. We assessed
safety and effectiveness of Methotrexate (MTX) administration within the
sub-chorionic space under hysteroscopic guidance, followed by resectoscopic
placental removal. Methods: Five patients suffering from type 2 CSP
underwent a sequential treatment based on hysteroscopic techniques. Pregnancy
termination was firstly obtained by injection of 80 mg of MTX within the
intervillous spaces of placental site. The intervention was performed in an
office setting using a 16Fr hysteroscope. MTX was administered by a 17-gauge
needle suitable for the operative channel of hysteroscope. Subsequently, based on
the decline of Human Chorionic Gonadotropin -subunit (-HCG), we
timed a placental removal using a 27-Fr resectoscope, under conscious sedation.
Results: In all women a diagnosis of CSP was achieved between 6 and 8
gestational age weeks. Hysteroscopic MTX administration resulted easily, quickly,
painlessly and uneventfully in all patients. A substantial decrease of
-HCG was obtained in all patients within 15 days from the MTX
administration. After a mean time of 27 days from MTX a resectoscopic removal of
CSP was carried-out without any recorded adverse outcome. After 30 days from
surgery -HCG returned to non-pregnant level and normal physical findings
were found in all patients. Conclusions: Hysteroscopy-guided MTX
sub-chorionic administration resulted safe and effective for CSP termination. It
was followed by successful and uneventful resectoscopic placenta removal in all
patients. When hysteroscopy facilities are available, this combined therapy can
be an option to treat CSP.