Diagnostic And Clinical Challenges In Managing Scar Ectopic Pregnancy: A Case Series

Authors

  • Yugantika Tomar

Keywords:

Menopause, Mental health, Hormonal fluctuations, Mood disorders, Anxiety, Depression

Abstract

Background: This rare but devastating type of ectopic implantation in which the pregnancy takes place within the myometrium at the location of a previous lower-segment cesarean section scar is called scar ectopic pregnancy, and especially cesarean scar ectopic pregnancy (CSEP). The increasing number of cesarean sections performed all over the world has been followed by an increase in this condition, which poses great diagnostic and therapeutic difficulties to obstetricians.

Objective: This series of cases will attempt to describe the range of presentations of cesarean scar ectopic pregnancies, describe the intricacies of diagnosing the condition, and review the varied management options varying from conservative medical treatment to surgery.

Methods and Cases: This report details eight cases of ectopic pregnancy in the cesarean scar managed at the authors' center. Each case was unique regarding gestational age, clinical stability, diagnostic workup, and definitive treatment. The approaches employed included medical management (methotrexate, ultrasound-guided potassium chloride injection) and surgical methods (scar excision, hysterectomy).

Conclusion: The early detection of ectopic implantation might be considered dangerous, if any suspicion might enter into the minds of the evaluators. Ultimately the treatment route must depend upon such factors as hemodynamic stability, the wish for subsequent fertility of the woman, gestational age, and what resources are available locally. This series of cases describes the significance of early clinical identification of red flag signs, proper imaging techniques, and prompt management aimed at minimizing morbidity and preserving fertility whenever it can be.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Haberman S, Saraf S, Zhang J, Landy HJ, Branch DW, Burkman R, et al. Nonclinical parameters affecting primary cesarean rates in the United States. Am J Perinatol. 2014;31:213–22.

Klemetti R, Che X, Gao Y, Raven J, Wu Z, Tang S, et al. Cesarean section delivery among primiparous women in rural China: an emerging epidemic. Am J Obstet Gynecol. 2010;202:e1–6.

Rotas MA, Haberman S, Levgur M. Caesarean scar ectopic pregnancies: aetiology, diagnosis, and management. Obstet Gynecol. 2006;107:1373–81.

Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006;107(6):1373–81.

Einenkel J, Stumpp P, Kosling S, Horn LC, Hockel M. A misdiagnosed case of caesarean scar pregnancy. Arch Gynecol Obstet. 2005;271(2):178–81.

Weimin W, Wenqing L. Effect of early pregnancy on a previous lower segment cesarean section scar. Int J Gynaecol Obstet. 2002;77(3):201–7.

Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012;207(1):14–29.

Cali G, Timor-Tritsch IE, Palacios-Jaraquemada J, Monteagudo A, Buca D, Forlani F, et al. Outcome of cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(2):169–75.

Wang CB, Chien SC, Lee CY, Lee YC, Chen TC. Cesarean scar pregnancy: diagnosis and management. Ultrasound Obstet Gynecol. 2006;27(2):222–6.

Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol. 2003;21(3):220–7.

Fuchs T, Henrich W, Ostermann K, Dudenhausen JW. Sonographic diagnosis of cesarean scar pregnancy and successful medical treatment with methotrexate. Ultrasound Obstet Gynecol. 2004;23(5):563–5.

Tang A, Baartz D, Cario G. Cesarean scar pregnancy: a localized form of placenta accreta and its implications. Aust N Z J Obstet Gynaecol. 2013;53(2):208–10.

Maymon R, Halperin R, Mendlovic S, Schneider D, Vaknin Z, Herman A. Efficacy and safety of fertility-preserving treatment in patients with cesarean scar pregnancies: a prospective single-center trial. Fertil Steril. 2011;95(2):601–4.

Peng P, Liu Y, Wei H, Zhai J, Lu X. Diagnostic value of MRI in cesarean scar pregnancy: a systematic review and meta-analysis. J Magn Reson Imaging. 2020;51(1):205–16.

Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG. 2007;114(3):253–63.

Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, Svarre Nielsen H. Cesarean scar pregnancy: diagnosis and treatment. A review of the literature. Eur J Obstet Gynecol Reprod Biol. 2016;205:130–40.

Jurkovic D. Cesarean scar pregnancy and placenta accreta. Ultrasound Obstet Gynecol. 2020;55(3):359–60.

Miller R, Timor-Tritsch I, Gyamfi-Bannerman C. Society for Maternal–Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy. Am J Obstet Gynecol. 2020;222(4):B2–14.

Downloads

Published

2025-05-12

How to Cite

1.
Tomar Y. Diagnostic And Clinical Challenges In Managing Scar Ectopic Pregnancy: A Case Series. J Neonatal Surg [Internet]. 2025May12 [cited 2025Sep.20];14(23S):17-22. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/5678