Caesarean Scar Pregnancy: A Case Report and a Literature Review

Abstract

Background and Objectives: Caesarean scar pregnancy (CSP) refers to placental implantation on or in the scar of a previous caesarean section and represents a potentially life-threatening condition. CSP is considered a diagnostic challenge in obstetrics, with the diagnosis relying mainly on transvaginal ultrasound (TVS) and the management depending upon case presentation and available healthcare infrastructures. Case Presentation: We present a case of 34-year-old G3P2 with a history of two-previous caesarean sections referred to the outpatient gynaecology clinic of our Department at the 7th week (7/40) of gestation with abnormal early pregnancy TVS findings, illustrating the gestational sac attached to the caesarean scar and a foetal pole with evidence of foetal cardiac activity. We discuss the outcome of an alternative combined medical and surgical approach we followed as well as an updated review of the current literature. Conclusions: The ideal management of CSP requires tertiary centers, equipment availability and experienced healthcare professionals capable of dealing with any possible complication, as well as individualized treatment based on each case presentation.

Outcome and treatment of caesarean scar ectopic pregnancy under ultrasound-guided vacuum aspiration preceded by local methotrexate sac injection

“…Systemic MTX is successful when serum βhCG is < 5000 mIU/ml and myometrium thickness is < 2 mm. Systemic MTX had a success rate of 71-80%, with only 6% requiring hysterectomy 14 . Apart from MTX, local injection of potassium chloride (KCL), hyperosmolar glucose, etoposide, and crystallized trichosanthin has been reported 15 .…”

A combination of laparoscopy and bilateral uterine artery occlusion for the treatment of type II cesarean scar pregnancy: a retrospective analysis

“…Several approaches have been developed to limit the blood loss that occurs during the management of CSP, including uterine artery embolization (UAE), intramyometrial injection of vasoconstrictors, and the placement of a Foley balloon catheter. [6][7][8][9][10] However, to date, no consensus has been reached regarding the best treatment method.…”

Single-Center Insights into Cesarean Scar Pregnancy: Treatment Strategies and Determinants

“…To date, no standardized treatment protocol exists for CSP. Treatment plans are typically tailored based on the patient's overall condition, including clinical symptoms, gestational age (GA), serum β-human chorionic gonadotropin (β-hCG) levels, mass size, CSP classification, and other factors [5,6]. This retrospective study reports on the management of 220 patients diagnosed with CSP at our institution, involving various treatment methods including dilation and curettage (D&C), curettage after uterine artery embolization (UAE+C), hysteroscopy plus curettage (H/S+C), H/S+C following UAE (UAE+H/S+C), and hysteroscopy combined with laparoscopic resection (L/S+H/S).…”