Review Article
Volume 9 Issue 12 - 2020
Current Trends in Management of Caesarean Scar Pregnancy
Suneeta Mittal1* and Pakhee Aggarwal2
11Professor, Director and Head, Department of Obstetrics and Gynecology, Fortis Memorial Research Institute, Gurugram, NCR, India
22Senior Consultant, Department of Obstetrics and Gynecology, Fortis Memorial Research Institute, Gurugram, NCR, India
*Corresponding Author: Suneeta Mittal, Professor, Director and Head, Department of Obstetrics and Gynecology, Fortis Memorial Research Institute, Gurugram, NCR, India.
Received: June 12, 2020; Published: November 07, 2020


There is a global rise in number of caesarean scar ectopic pregnancies parallel with increasing trend towards operative deliveries. There is a diagnostic as well as management dilemma in these cases. There is no consensus yet on optimal management. Current trends with their pros and cons are discussed.

Keywords: Caesarean Scar Ectopic; Methotrexate; KCL; Uterine Artery Embolization; Hysteroscopy; Laparoscopy; Evacuation


  1. Barnhart K., et al. “An update on the medical treatment of ectopic pregnancy”. Obstetrics and Gynecology Clinics of North America 27 (2000): 653-667.
  2. Birge Ö., et al. “Medical management of cesarean scar pregnancy at advanced age: case report and literature review”. Clinical and Experimental Obstetrics and Gynecology 1 (2016): 140-142.
  3. Valley MT., et al. “Cesarean scar pregnancy: imaging and treatment with conservative surgery”. Obstetrics and Gynecology 91 (1998): 838.
  4. Rotas MA., et al. “Cesarean scar ectopic pregnancies: etiology, diagnosis, and management”. Obstetrics and Gynecology 107 (2006): 1373.
  5. Wong KS., et al. “Myomectomy scar ectopic pregnancy”. Australian and New Zealand Journal of Obstetrics and Gynaecology 50 (2010): 93.
  6. Marchiolé P., et al. “Intramural pregnancy embedded in a previous Cesarean section scar treated conservatively”. Ultrasound in Obstetrics and Gynecology 23 (2004): 307.
  7. Ash A., et al. “Caesarean scar pregnancy”. An International Journal of Obstetrics and Gynaecology 114 (2007): 253.
  8. Ofili-Yebovi D., et al. “Deficient lower-segment Cesarean section scars: prevalence and risk factors”. Ultrasound in Obstetrics and Gynecology 31 (2008): 72.
  9. Chueh HY., et al. “Ectopic twin pregnancy in cesarean scar after in vitro fertilization/embryo transfer: case report”. Fertility and Sterility 5 (2008): e19-e21.
  10. Vial Y., et al. “Pregnancy in a cesarean scar”. Ultrasound in Obstetrics and Gynecology 16 (2000): 592.
  11. Einenkel J., et al. “A misdiagnosed case of caesarean scar pregnancy”. Archives of Gynecology and Obstetrics 2 (2005): 178-181.
  12. Calì G., et al. “Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy”. International Journal of Gynecology and Obstetrics 140 (2018): 319.
  13. Armstrong V., et al. “Detection of cesarean scars by transvaginal ultrasound”. Obstetrics and Gynecology 101 (2003): 61.
  14. Monteagudo A., et al. “Saline infusion sonohysterography in nonpregnant women with previous cesarean delivery: the "niche" in the scar”. Journal of Ultrasound in Medicine 20 (2001): 1105.
  15. Lee SR., et al. “Cesarean scar pregnancy associated with an impending uterine rupture diagnosed with 3-dimensional ultrasonography”. American Journal of Obstetrics and Gynecology 216 (2017): 531.e1.
  16. Shih JC. “Cesarean scar pregnancy: diagnosis with three-dimensional (3D) ultrasound and 3D power Doppler”. Ultrasound in Obstetrics and Gynecology 23 (2004): 306.
  17. Timor-Tritsch IE., et al. “Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester”. American Journal of Obstetrics and Gynecology 2 (2016): 225.e1-7.
  18. De Vaate AJ., et al. “Therapeutic options of caesarean scar pregnancy: case series and literature review”. Journal of Clinical Ultrasound 2 (2010): 75-84.
  19. Zong L., et al. “Successful Treatment of a Recurrent Cesarean Scar Pregnancy by Transvaginal Cesarean Scar Pregnancy Lesion Resection: A Case Report”. The Journal of Reproductive Medicine 11-12 (2016): 595-597.
  20. Wang CN., et al. “Successful management of heterotopic cesarean scar pregnancy combined with intrauterine pregnancy after in vitro fertilization-embryo transfer”. Fertility and Sterility 88 (2007): 706.e13-6.
  21. Kucera E., et al. “Ektopická gravidita v jizvĕ po císarském rezu [Cesarean scar ectopic pregnancy]”. Ceská Gynekologie 3 (2007): 207-213.
  22. Huang L., et al. “High-intensity focused ultrasound combined with dilatation and curettage for Cesarean scar pregnancy”. Ultrasound in Obstetrics and Gynecology1 (2014): 98-101.
  23. Wang CJ., et al. “Hysteroscopic management of heterotopic cesarean scar pregnancy”. Fertility and Sterility 41529 (2010): e15-e18.
  24. Timor-Tritsch IE., et al. “Cesarean scar pregnancies: experience of 60 cases”. Journal of Ultrasound in Medicine 4 (2015): 601-610.
  25. Yela DA and Marchiani N. “Tratamento conservador da gravidez ectópica em cicatriz de cesárea: relato de caso [Conservative management of ectopic pregnancy in cesarean scar: case report]”. The Brazilian Journal of Gynecology and Obstetrics 5 (2013): 233-237.
  26. Yang MJ and Jeng MH. “Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases”. The Journal of Reproductive Medicine 3 (2003): 213-216.
  27. Bolanca I., et al. “Repeated cesarean scar pregnancy - Case report”. Clinical and Experimental Obstetrics and Gynecology 5 (2016): 774-776.
  28. Goynumer G., et al. “Treatment of a viable caesarean scar pregnancy with transvaginal methotrexate and potassium chloride injection”. Archives of Gynecology and Obstetrics 5 (2009): 869-872.
  29. Michaels AY., et al. “Outcome of cesarean scar pregnancies diagnosed sonographically in the first trimester”. Journal of Ultrasound in Medicine 4 (2015): 595-599.
  30. Graesslin O., et al. “Conservative treatment of ectopic pregnancy in a cesarean scar”. Obstetrics and Gynecology 105 (2005): 869.
  31. Elito Júnior J., et al. “Uterine artery embolization with methotrexate infusion as treatment for cesarean scar pregnancy. Case report”. Medical Ultrasonography 3 (2013): 240-243.
  32. Kiley J and Shulman LP. “Cesarean scar ectopic pregnancy in a patient with multiple prior cesarean sections: a case report”. The Journal of Reproductive Medicine 4 (2009): 251-254.
  33. Holland MG and Bienstock JL. “Recurrent ectopic pregnancy in a cesarean scar”. Obstetrics and Gynecology 111 (2008): 541-545.
  34. Colomé C., et al. “Conservative treatment by endoscopy of a cesarean scar pregnancy: two case reports”. Clinical and Experimental Obstetrics and Gynecology 2 (2009): 126-129.
  35. Lee CL., et al. “Laparoscopic management of an ectopic pregnancy in a previous Caesarean section scar”. Human Reproduction 5 (1999): 1234-1236.
  36. Api M., et al. “Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature”. Journal of Minimally Invasive Gynecology 7 (2015): 1145-1152.
  37. Polat I., et al. “Suction curettage as first line treatment in cases with cesarean scar pregnancy: feasibility and effectiveness in early pregnancy”. Journal of Maternal-Fetal and Neonatal Medicine 7 (2016): 1066-1071.
  38. Deans R and Abbott J. “Hysteroscopic management of cesarean scar ectopic pregnancy”. Fertility and Sterility (93 (2010): 1735.
  39. Ben Nagi J., et al. “Reproductive outcomes of women with a previous history of Caesarean scar ectopic pregnancies”. Human Reproduction 22 (2007): 2012.
  40. Seow KM., et al. “Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy”. Acta Obstetricia et Gynecologica Scandinavica 83 (2004): 1167.
  41. Rosen T. “Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate”. Clinics in Perinatology 35 (2008): 519.
  42. Society for Maternal-Fetal Medicine (SMFM). “Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy”. American Journal of Obstetrics and Gynecology 222 (2020): B2.
Citation: Suneeta Mittal and Pakhee Aggarwal. “Current Trends in Management of Caesarean Scar Pregnancy”. EC Gynaecology 9.12 (2020): 23-28.

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