Case 4: A 32 -year-old woman, gravida 4 para 5, was admitted toour ward complaining of pelvic pain and slight vaginal bleeding. Herpertinent history included a cesarean section for breech presentationas well as one dilatation and curettage. A transvaginal ultrasoundscan revealed a gestational sac within the anterior wall of the uterus,3.8 cm from the external os, surrounded by myometrium andpressing anteriorly on the urinary bladder. An embryonic pole wasidentified with a crown-rump length of 4 mm, corresponding to7+4weeks’ gestation. Fetal cardiac activity was detected. A diagnosis ofa viable pregnancy in a uterine scar was made. She was treated withan intramuscular injection of 50 mg/m2 methotrexate 2 days later asuction curettage was performed and B-HCG the values were 1248, 243and <6 mIU/ml on days, 2, 8 an 13 after the evacuation (Figure 4).
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