Published: 2018-05-26

Cesarean scar pregnancy: an upcoming challenge

Sunil K. Juneja, Pooja Tandon, Bhanupriya .


Background: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy implanted in the myometrium at the site of previous cesarean scar. Incidence of cesarean deliveries are increasing globally, leading to rise in incidence of cesarean scar pregnancy. Caesarean scar pregnancies are associated with some life-threatening complications such as scar rupture, haemorrhage, disseminated intravascular coagulation, requiring lifesaving hysterectomy. We present our experience with 11 patients with cesarean scar pregnancy, diagnosed using transvaginal colour doppler ultrasound during 3-year period and treated conservatively to preserve the uterus with successful outcome in all patients.

Methods: This was a retrospective study, conducted in the Department of Obstetrics and Gynecology of DMC&H, Ludhiana from January 2015 to December 2017. Out of total deliveries (4278), 3.9% (171/4278) were diagnosed as ectopic pregnancy. 6.43% (11/171) of them were diagnosed as cesarean scar ectopic pregnancy. After counseling, all patients underwent conservative management. Injection methotrexate 50mg was administered intramuscularly and beta- HCG was monitored after 4 days and then weekly till it was <1.

Results: 2 patients had an increase in beta HCG levels on day 7 and required second dose of methotraxate. 8 patients required blood transfusion due to excessive bleeding on admission. In 9 patients beta HCG levels reduced to <1 in 7 weeks post first methotraxate dose administration, and in remaining 3 it returned to <1 after 8 weeks . No patient required any surgical intervention.

Conclusions: Cesarean scar pregnancy, a type of ectopic pregnancy can be safely managed conservatively if diagnosed early.


Cesarean scar, Challenge, Pregnancy

Full Text:



Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379-87.

Betran AP, Torloni MR, Zhang JJ, et al. WHO Statement on caesarean section rates. BJOG. 2016;123(5):667-70.

Gibbons L, Belizan JM, Lauer JA, BetrĂ¡n AP, Merialdi M, Althabe F. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. World Health Rep. 2010;30:1-31.

Winder SR, Condous G. Ultrasound Diagnosis of Ectopic Pregnancy. AJUM. 2011;14 (2):29-33.

Clark EA, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011;205:S2-10.

Collins K, Kothari A. Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound. Australasian Journal of Ultrasound in Medicine. 2015;18(4):150-6.

Seow KM, Cheng WC, Chuang J, Lee C, Tsai YL, Hwang JL. Methotrexate for cesarean scar pregnancy after in vitro fertilization and embryo transfer. A case report. J Reprod Med. 2000;45:754-7.

Alammari R, Thibodeau R, Harmanli O. Vaginal hysterectomy for treatment of cervical ectopic pregnancy. Obstet Gynecol. 2017;129:63-5.

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114:253-63.

Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus: an unusual cause of postabortal haemorrhage. A case report. S Afr Med J. 1978;53:142-3.

Timor-Tritsch IE, Monteagudo A, Cali G. Palacios-Jaraquemada JM, Maymon R, Arslan AA, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol. 2014;43:383-95.

Osborn DA, Williams TR, Craig BM. Cesarean scar pregnancy: sonographic and magnetic resonance imaging fndings, complications, and treatment. J Ultrasound Med. 2012;31(9):1449-56.

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373-81.

Jurkovic D, Jauniaux E, Kurjak A, Hustin J, Campbell S, Nicolaides KH. Transvaginal color Doppler assessment of the uteroplacental circulation in early pregnancy. Obstet Gynecol. 1991;77:365-9.

Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 2004;10:515523.

Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Cesarean scar pregnancy: a systematic review of treatment studies. Fertil Steril. 2016;105(4):958-67.