Successful management of a triplet heterotopic caesarean scar pregnancy after in vitro fertilization-embryo transfer.
OBJECTIVE
To report a case of a triplet heterotopic caesarean scar pregnancy (CSP) with two gestational sacs implanted in the caesarean scar after in vitro fertilization-embryo transfer.


METHODS
Case report.


METHODS
Private reproductive medicine center and obstetric department of a university hospital.


METHODS
A 31-year-old woman with previous caesarean section affected by secondary infertility related to male azoospermia.


METHODS
In vitro fertilization-embryo transfer followed by early ultrasound diagnosis of heterotopic CSP and selective embryo reduction performed by transvaginal ultrasound-guided potassium chloride and methotrexate injection in the ectopic gestational sacs.


METHODS
Successful pregnancy outcome.


RESULTS
An ongoing intrauterine pregnancy with a live birth after successful management of ectopic gestational sacs.


CONCLUSIONS
Triplet heterotopic CSP with two ectopic gestational sacs may occur after IVF-ET and, to our knowledge, this is the first time such a complication has been reported. Ultrasound is the main tool allowing early diagnosis of this condition, and the injection of potassium chloride and methotrexate is a safe and efficacious treatment method. The gynecologist managing early pregnancy should be aware of the possibility of CSP, and patients must be appropriately counseled about the different treatment options.
Litwicka
Katarzyna
K
Assisted Reproduction Centre, European Hospital, Rome, Italy. Litwicka@yahoo.it
Greco
Ermanno
E
Prefumo
Federico
F
Fratelli
Nicola
N
Scarselli
Filomena
F
Ferrero
Susanna
S
Iammarrone
Elisabetta
E
Frusca
Tiziana
T
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000209:etiology; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011189:Potassium Chloride / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*; D011271:Pregnancy, Ectopic / Q000628:therapy*; D014310:Triplets
D000020:Abortifacient Agents, Nonsteroidal; D011189:Potassium Chloride; D008727:Methotrexate