Cesarean Scar Pregnancy Spectrum: A Proposed Standardized Classification and Terminology for the Reporting of Pregnancy Developing in Uterine Cesarean Scar.

Abstract

This article contains the academic, but more importantly clinical debate of the terminology of pregnancies after cesarean deliveries, namely cesarean scar pregnancies as well as increasingly relevant social aspects determining their management. Its main purpose is to offer a solution to the controversy created by the debate about the terminology of pregnancies implanted in, or on the uterine scar left behind by a cesarean delivery. The 2 opposing terms creating the argument are: cesarean scar pregnancy and cesarean scar ectopic pregnancy. They seem to exhibit a spectrum of different pathophysiologic properties and outcomes with different outcomes almost regardless of their expectant or surgically management. Based upon the above and modeled by the creation of the entity called "placenta accreta spectrum" which also contains clinico-pathologically slightly but different entities, we suggest unifying the terminology of cesarean scar pregnancies. By creating an all-encompassing term: cesarean scar pregnancy spectrum that includes the different presentations, various levels of their clinical severities and associated complications. Categorizing cesarean scar pregnancies as "on-scar cesarean scar pregnancy (oCSP)" and cesarean scar ectopic pregnancy (CSeP), distinguishes the clinical presentation and risk stratification. While all CSPs carry risk, this not only will make the reporting to permit some shared decision-making for expectant management of oCSP, but also will better inform the patient of the potential risk and the treatment for CSeP depending on which end of the spectrum the cesarean scar pregnancy was found.