Counseling and Management of a Conservatively Managed Second Trimester Cesarean Scar Pregnancy: A Case Report.

Background: Cesarean scar ectopic pregnancies (CSPs) are becoming more prevalent and can have an extremely poor prognosis, with high morbidity and mortality. Management guidelines for patients desiring conservative treatment should be established to improve outcomes.

Case: A 33-year-old woman with a conservatively managed CSP now in the second trimester presented from an outside institution. After thorough counseling regarding potential maternal morbidity and extreme prematurity in the newborn based on clinical findings of progressive cervical shortening and vaginal spotting with a significant drop in hemoglobin, she abandoned conservative therapy and underwent a hysterectomy with the previable fetus in situ.

Conclusion: As pregnancy progresses, danger to the mother and fetus can become severe and imminent. Progressive cervical shortening may be associated with much more significant bleeding than evidenced by spotting, indicating the importance of using cervical shortening in abandonment of conservative management to reduce impending morbidity and mortality.