Fertility-preserving management of heterotopic cesarean scar pregnancy after laparoscopic repair for cesarean scar disorder: a case report.

Heterotopic pregnancy involving cesarean scar implantation is rare and difficult to manage when continuation of a viable intrauterine pregnancy is desired. Evidence is particularly limited for cases occurring after surgical repair for cesarean scar disorder. A 40-year-old woman with three previous cesarean deliveries underwent laparoscopic repair for symptomatic cesarean scar disorder before assisted reproductive technology. After transfer of two blastocysts, transvaginal ultrasonography showed a viable intrauterine pregnancy together with a cesarean scar pregnancy of the in-the-niche type with minimal overlying residual myometrium. Because the patient wished to continue the intrauterine pregnancy, selective treatment of the scar gestation was performed. Ultrasound-guided local potassium chloride injection led to gradual regression of the cesarean scar pregnancy without significant bleeding or procedure-related complications. The intrauterine pregnancy continued under close surveillance, and an elective repeat cesarean delivery at 37 weeks resulted in the birth of a healthy neonate. Histopathology of residual tissue at the repaired scar was compatible with a placental remnant. Selective local potassium chloride injection may be considered a fertility-preserving option for heterotopic cesarean scar pregnancy after surgical repair for cesarean scar disorder in carefully selected patients. Early diagnosis, careful counseling, and management in a tertiary care setting are essential.