title: Cesarean scar ectopic pregnancy: a case report of failed combination local and systemic methotrexate management requiring surgical intervention.
abstract: BACKGROUND
  Cesarean scar ectopic pregnancies have been diagnosed with increasing frequency in the last decade. There is no consensus of management for these pregnancies; however, prior reports have suggested best results using either combination methotrexate therapy or surgical excision.
  
  
  METHODS
  We present a case of failed systemic and local methotrexate therapy requiring operative management,
  
  
  CONCLUSIONS
  Cesarean scar ectopic pregnancies can have disastrous outcomes, including uterine rupture, massive hemorrhage and maternal death. Although this is the first case to report a failure of the combination therapy, major morbidities did not occur. We believe this is due to our choice of expedient surgical management.
authors.affiliation: Department of Obstetrics and Gynecology, Stony Brook University Medical Center, Stony Brook, NY 11733, USA. erin.e.stevens@gmail.com
authors.forename: Erin E
authors.initials: EE
authors.lastname: Stevens
authors.forename: Paul
authors.initials: P
authors.lastname: Ogburn
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000328:Adult; D002585:Cesarean Section; D002921:Cicatrix / Q000150:complications*; D004107:Dilatation and Curettage / Q000379:methods; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery*; D017211:Treatment Failure; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate