Cesarean Scar Pregnancy: Three case reports and literature review

Abstract

Introduction

Cesarean Scar Pregnancy (CSP) is defined as an ectopic pregnancy in which the gestational sac implants on the surgical scar of a previous cesarean section or isthmocele.

Despite its low incidence, the diagnosis presents a significant difficulty, and a false negative diagnosis can lead to serious complications that may require more aggressive treatments.

Objective

The main objective of this study is to present three clinical cases of patients with suspected ectopic pregnancy in the cesarean scar, including a review of the current literature on this condition.

Methods

The clinical case data were obtained from the patients’ medical records, including the results of the additional tests performed, as well as subsequent gynecology appointments. On the other hand, a literature review was conducted on ectopic pregnancies in the cesarean scar.

Results

During ultrasound examinations of patients with a history of previous cesarean sections, special attention should be paid to identifying the implantation site of the gestational sac to rule out CSP.

Due to the limited number of trials and case reports on CSP, there is no consensus on standardized treatment and management. The primary goal is to preserve patient's fertility and avoid severe complications such as massive hemorrhage or uterine rupture.

Conclusions

Cesarean Scar Pregnancy (CSP) should be considered among the diagnostic options when finding a gestational sac located in atypical situations in patients with a history of cesarean section.

Early diagnosis and treatment are crucial for achieving the best outcomes. A minimally invasive approach should be planned as first-line treatment in all situations where CSP is included in the differential diagnosis.