title: Successful selective reduction of a heterotopic cesarean scar pregnancy in the second trimester: a case report and review of the literature.
abstract: Heterotopic cesarean scar pregnancy is a cesarean scar pregnancy combined with an intrauterine pregnancy that predisposes a woman to life-threatening complications such as uterine rupture and massive bleeding. Preservation of the intrauterine pregnancy in heterotopic cesarean scar pregnancy is a great challenge.
  
  
  
  We report a case of a 33-year-old woman with heterotopic cesarean scar pregnancy after IVF-embryo transfer (ET). Expectant management was carried out with early diagnosis of heterotopic cesarean scar pregnancy (HCSP), and selective fetal reduction of cesarean scar pregnancy (CSP) was performed by ultrasound-guided intrathoracic injection of potassium chloride (KCl) at 16 + 4 weeks of gestation due to aggravation of CSP. Preservation of the intrauterine pregnancy was successful and a healthy baby was delivered by cesarean section at 37 + 6 weeks of gestation.
  
  
  
  Heterotopic cesarean scar pregnancy is an extremely rare form of heterotopic pregnancy. Patients should be appropriately counseled regarding the different treatment options available. An ultrasound-guided injection of potassium chloride may constitute a safe, minimally invasive and reliable way to terminate the heterotopic gestation and preserve the intrauterine pregnancy. Intensive management should be performed during the ongoing pregnancy and cesarean section.
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.|Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No.20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China. luohongcd1969@163.com.|Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No.20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China. luohongcd1969@163.com.
authors.forename: Hong
authors.initials: H
authors.lastname: Luo
authors.affiliation: Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.|Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No.20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
authors.forename: Fumin
authors.initials: F
authors.lastname: Zhao
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.|Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No.20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China.
authors.forename: Xinghui
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China. wangxd_scu@sina.com.|Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, No.20, 3rd section, South Renmin Road, Chengdu, Sichuan, 610041, China. wangxd_scu@sina.com.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000188:drug therapy / Q000209:etiology*; D004624:Embryo Transfer / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007267:Injections / Q000379:methods; D050498:Live Birth; D011189:Potassium Chloride / Q000008:administration & dosage; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011271:Pregnancy, Ectopic / Q000188:drug therapy / Q000209:etiology*; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods
chemical_list: D011189:Potassium Chloride
keywords: Expectant management; Heterotopic cesarean scar pregnancy; Potassium chloride; Selective fetal reduction