title: Expectant management of heterotopic cesarean scar pregnancy.
abstract: BACKGROUND
  Heterotopic cesarean scar pregnancy (HCSP) is a very rare but life-threatening entity and there is no optimal management strategy. Here we report a successfully managed case of HCSP with expectant treatment in a tertiary referral hospital.
  
  
  METHODS
  A woman with HCSP after in vitro fertilization-embryo transfer opted for expectant treatment after five days of mild bleeding and ultrasound demonstrated cardiac activity disappearance of the scar pregnancy at 8(+4) weeks of gestation.
  
  
  RESULTS
  The patient had mild to moderate bleeding during close monitoring. Three days later, speculum examination revealed the gestational mass was partly protruding at the os of the cervix and it was removed with forceps without massive hemorrhage. A healthy male baby was delivered by cesarean section at gestational age of 36(+4) weeks.
  
  
  CONCLUSIONS
  The expectant method might be an alternative option for a HCSP with loss of cardiac activity of the scar pregnancy, when applied under supportive management and with available emergency surgery facilities.
authors.affiliation: Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Xiao-xia
authors.initials: XX
authors.lastname: Bai
authors.forename: Hui-juan
authors.initials: HJ
authors.lastname: Gao
authors.forename: Xiao-fu
authors.initials: XF
authors.lastname: Yang
authors.forename: Ming-yue
authors.initials: MY
authors.lastname: Dong
authors.forename: Yi-min
authors.initials: YM
authors.lastname: Zhu
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging*; D014463:Ultrasonography