First-Trimester Diagnosis and Management of Pregnancies Implanted Into the Lower Uterine Segment Cesarean Section Scar

Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes

“…This phenomenon is considered rare, occurring in 1 out of 1800 to 1 out of 2500 pregnancies [1][2][3]. However, it is becoming more common due to the increased number of cesarean sections being performed as well as the decline in vaginal deliveries after previous cesarean section and now accounts for 6.1 % of all ectopic pregnancies [1,4].…”

“…If this abnormal implantation is unrecognized and allowed to progress, it may result in devastating complications including placental abnormalities such as accreta, life-threatening maternal hemorrhage, and uterine rupture [5][6][7]. Multiple cesarean sections increase the risk of scar implantation [1], presumably due to an increased surface area of the scar. Early diagnosis with sonography ( Fig.…”

Angiographic uterine artery chemoembolization followed by vacuum aspiration: an efficient and safe treatment for managing complicated cesarean scar pregnancy

“…To preserve patient's future fertility, termination of pregnancy should be suggested in the Wrst trimester prior to uterine rupture [1,4]. However, it is diYcult to decide on the optimal management because there is no universal agreement on the best treatment modality.…”

“…Two principal management opinions for termination of pregnancy may be considered, the medical or the surgical. The medical treatment mainly consists of systemic or local administration of methotrexate (MTX), local injection of potassium chloride or hyperosmolar glucose [1,3,4]. The surgical alternative includes uterine curettage, uterine artery embolization, hysteroscopy evacuation, laparotomy or laparoscopy to excise the gestational sac from the cesarean scar [4,[6][7][8].…”

“…The development of a gestational sac within the previous cesarean scar is considered to be the rarest form of ectopic pregnancy, but the incidence and the diagnostic rate have been rising during the past decade because of the worldwide rising cesarean section rates or comprehensive use of more accurate imaging methods such as tansvaginal ultrasound, three-dimensional ultrasound, and magnetic resonance imaging (MRI) [1,2]. There are several theories to explain cesarean scar pregnancy (CSP), the most notable mechanism is that the blastocyst invades myometrium through a microscopic dehiscent tract [2,3].…”