Cesarean Scar Pregnancy: A Case Report

Abstract

Introduction: A relatively new type of ectopic pregnancy is cesarean scar pregnancy (CSP). This is related to the increasing number of cesarean deliveries and to the advances in imaging. There are 2 types of CSP; CSP with progression to cervicoisthmic space or uterine cavity (type I, endogenic type) or with deep invasion of scar defect with progression towards bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSP could result in a viable pregnancy; yet with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. As early diagnosis and treatment is important for the best outcome, every pregnant woman with history of cesarean delivery should be screened early in the first trimester of pregnancy. Diagnosis can be achieved with ultrasound and Doppler imaging. To date there have been only 5 randomized studies on CSP and evidence based management remains unclear. Until then, treatment should be individualized according to many factors including clinical presentation, β-hCG levels, imaging features, and the surgeon’s skill. We report a case of cesarean scar pregnancy successfully managed in our university hospital center.