Transvaginal repair of caesarean scar dehiscence

well as patient preference. Alternatives include surgical wedge resection, hysteroscopic excision, local injection of potassium chloride and methotrexate. The main advantage of surgery is its definitive approach, whilst medical therapy can result in slow resolution, with attendant uncertainty and deterioration risk. However, in selected cases, medical management of hysteroscopy scar pregnancies have been successful and fertility-sparing. Expectant management is not considered an alternative given the real risks of rupture. Our case confirms the efficacy of methotrexate. However, it also highlights the challenges of medical management. The interval between time of diagnosis and ultimate resolution was six months. A significant commitment to follow-up was required from both the patient and her treating practitioners during this interval. In this setting, extensive counselling is mandatory. Of note, the choice of treatment here did not ultimately prevent occlusion of the patient’s right fallopian tube. Nevertheless, the success of this treatment prevented the need for surgical resection with its associated risks, including catastrophic haemorrhage and emergent hysterectomy.