This review examines cesarean scar pregnancy diagnosis, management options, and early detection methods, highlighting clinical implications.
Background: Cesarean scar pregnancy (CSP) is a rare but rising ectopic pregnancy where a blastocyst implants in fibrous tissue of a previous cesarean scar. Increasing cesarean rates make CSP more common, with risks of uterine rupture, severe bleeding, placenta accreta spectrum (PAS), and fertility loss. It occurs when a blastocyst implants through a tiny myometrial defect, causing abnormal placental invasion. Early diagnosis by transvaginal ultrasound is key; typical signs are an empty uterine cavity, low anterior sac, thin myometrium, and increased scar vascularity. Management depends on gestational age, residual myometrial thickness (RMT), cardiac activity, and fertility goals. Options include monitoring, methotrexate (MTX), uterine artery embolization (UAE), or minimally invasive surgery. If RMT is ≤ 3 mm, surgical repair is advised to reduce recurrence. Multidisciplinary care in specialized centers ensures the best outcomes. Conclusion: CSP requires high clinical suspicion, early diagnosis, and tailored treatment to minimize morbidity and preserve reproductive potential.
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John et al. (2025) studied this question.
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