Pregnancy in a Uterine Scar: Modern Possibilities of Minimally Invasive Treatment

Currently, the problem of rare forms of ectopic pregnancy, such as pregnancy in the rumen after cesarean section, remains quite relevant. This is due to an increase in the number of cesarean sections and the development of imaging techniques. There are 2 main types of pregnancy in the uterine scar: with progression in the cervical-isthmic space or uterine cavity (type I, endogenous type) or with deep penetration into the scar with progression towards the bladder and abdominal cavity (type II, exogenous type). An endogenous type of invasion can lead to a viable pregnancy, accompanied by a high risk of bleeding at the site of invasion. The exogenous type can be complicated by rupture of the uterus and bleeding in early pregnancy. Since early diagnosis and treatment are important to achieve the best result, every pregnant woman with a history of cesarean section should be screened at the beginning of the first trimester of pregnancy. Minimally invasive, organ-preserving technologies and surgical techniques, such as temporary selective embolization of the uterine arteries, followed by hysteroscopy and evacuation of the fetal egg from the uterine cavity, are becoming increasingly relevant. This treatment method demonstrates sufficient efficacy and safety, especially for patients of reproductive age who are planning a subsequent pregnancy, which is currently relevant when choosing a treatment method. The selection of the optimal treatment method should be individual and depend on many factors, including the clinical picture, the level of human beta-chorionic gonadotropin, imaging features and qualifications of the surgeon, the possibility of transferring the patient to the 3rd level.