eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2019-03-25 12 1 99 105 10.13005/bpj/1618 26454 article Maha Al-Bassam 1 Muzibunnisa A. Begam 1 Saad Ghazal Aswad 1 Moamar Al-Jefout 1,2,3,4 The Department of Obstetrics and Gynecology, Tawam hospital, Al-Ain, UAE. The Department of Obstetrics and Gynecology, College of Medicine and Health Sciences (CM and HS), United Arab Emirates University, Al-Ain, UAE. The Department of Obstetrics and Gynecology, Faculty of Medicine, Mutah University, Jordan. Sechenov First Moscow State Medical University, Russian Federation. Caesarean scar ectopic pregnancy (CSEP) is considered an extremely rare entity, but life threatening, however, with the increase in C/S rates it is becoming a more common finding. To explore the possibility of utilizing ultrasound guided transvaginal aspiration and injection of 50 mg methotrexate followed by mechanical disruption as a promising primary treatment approach for CSEP. In a series of 11 cases at Tawam Hospital (UAE) diagnosed with CSEP, an ultrasound guided transvaginal aspiration of the amniotic fluid and gestational tissue, followed by injection of 50 mg Methotrexate into the remaining chorionic sac and then disruption of the sac with the needle. B-hCG level were measured on: day of procedure, day 1 or 2 after the procedure and then weekly. Final resolution was considered when B-hCG returned to < 5mIU/mL. All cases presented and diagnosed in the 1st trimester, mean gestational age at diagnosis was 6.6 weeks (range 5-10). The presenting symptoms were mainly lower abdominal pain and vaginal bleeding in 8/11 patients (73%) while three women were asymptomatic (27%) and CSEP was diagnosed incidentally at viability scan. Nine out of eleven cases showed cardiac activity (82%). B-hCG day 1 or 2 post procedure dropped in all cases but by variable levels, ranging from 1.1% to 74.7%, while the drop during days 7-10, was more significant and reassuring; ranged from 45.7% to 92.5 %. No complications were reported with 100% success rate. Ultrasound guided transvaginal aspiration and injection of 50 mg Methotrexate followed by needle mechanical disruption is a promising primary treatment approach for CSEP. However, more studies with more numbers are needed to further support this treatment method. https://biomedpharmajournal.org/vol12no1/ultrasound-guided-transvaginal-aspiration-and-mechanical-destruction-with-local-methotrexate-injection-is-a-promising-primary-treatment-approach-for-caesarean-scar-ectopic-pregnancy-csep/ Caesarean Scar Ectopic Pregnancy (CSEP) Methotrexate Therapy Ultrasound Guided Transvaginal Aspiration