Case 4: A 32 -year-old woman, gravida 4 para 5, was admitted to
our ward complaining of pelvic pain and slight vaginal bleeding. Her
pertinent history included a cesarean section for breech presentation
as well as one dilatation and curettage. A transvaginal ultrasound
scan revealed a gestational sac within the anterior wall of the uterus,
3.8 cm from the external os, surrounded by myometrium and
pressing anteriorly on the urinary bladder. An embryonic pole was
identified with a crown-rump length of 4 mm, corresponding to7+4
weeks’ gestation. Fetal cardiac activity was detected. A diagnosis of
a viable pregnancy in a uterine scar was made. She was treated with
an intramuscular injection of 50 mg/m2 methotrexate 2 days later a
suction curettage was performed and B-HCG the values were 1248, 243
and