title: Successful management of a triplet heterotopic caesarean scar pregnancy after in vitro fertilization-embryo transfer.
abstract: 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.
authors.affiliation: Assisted Reproduction Centre, European Hospital, Rome, Italy. Litwicka@yahoo.it
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Litwicka
authors.forename: Ermanno
authors.initials: E
authors.lastname: Greco
authors.forename: Federico
authors.initials: F
authors.lastname: Prefumo
authors.forename: Nicola
authors.initials: N
authors.lastname: Fratelli
authors.forename: Filomena
authors.initials: F
authors.lastname: Scarselli
authors.forename: Susanna
authors.initials: S
authors.lastname: Ferrero
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Iammarrone
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frusca
mesh_terms: 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
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D011189:Potassium Chloride; D008727:Methotrexate