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Review
. 2023 Apr 19;12(2):64-71.
doi: 10.4103/gmit.gmit_116_22. eCollection 2023 Apr-Jun.

Cesarean Scar Pregnancy: Current Understanding and Treatment Including Role of Minimally Invasive Surgical Techniques

Mohamed Siraj Shahul Hameed  1 , Ann Wright  2 , Bernard Su Min Chern  1
Affiliations
Review

Cesarean Scar Pregnancy: Current Understanding and Treatment Including Role of Minimally Invasive Surgical Techniques

Mohamed Siraj Shahul Hameed et al. Gynecol Minim Invasive Ther. .

Abstract

The incidence of cesarean scar pregnancy (CSP) is increasing reflecting the global increase in cesarean section (CS) rate which has almost doubled since 2000. CSP differs from other types of ectopic pregnancy in its ability to progress while still carrying a significant risk of maternal morbidity. Little is known about precise etiology or natural history although current interest in the pathology of placenta accretes spectrum disorders might be enlightening. Early detection and treatment of CSP are challenging. Once diagnosed, the recommendation is to offer early termination of pregnancy because of the potential risks of continuing the pregnancy. However, as the likelihood of future pregnancy complications for any CSP varies depending on its individual characteristics, this might not always be necessary nor might it be the patient's preferred choice if she is asymptomatic, hemodynamically stable, and wants a baby. The literature supports an interventional rather than a medical approach but the safest and most efficient clinical approach to CSP in terms of treatment modality and service delivery has yet to be determined. This review aims to provide an overview of CSP etiology, natural history, and clinical implications. Treatment options and methods of CSP repair are discussed. We describe our experience in a large tertiary center in Singapore with around 16 cases/year where most treatment modalities are available as well as an "accreta service" for continuing pregnancies. We present a simple algorithm for approach to management including a method of triaging for those CSPs suitable for minimally invasive surgery.

Keywords: Cesarean scar defect; cesarean scar pregnancy; high-intensity focus ultrasound; hysteroscopy; laparoscopy; methotrexate.

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Conflict of interest statement

Prof. Bernard Su Min Chern, an editorial board member at Gynecology and Minimally Invasive Therapy, had no role in the peer review process of or decision to publish this article. The other authors declared no conflicts of interest in writing this paper.

Figures

Figure 1
Figure 1
Algorithm for surgical management of cesarean scar pregnancy. CSP: Cesarean scar pregnancy, RMT: Residual myometrial thickness, COS: Cross-over sign
Figure 2
Figure 2
Cesarean scar pregnancy according to the RMT. RMT: Residual myometrial thickness
See this image and copyright information in PMC

References

    1. 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. - PubMed
    1. Litwicka K, Greco E. Caesarean scar pregnancy:A review of management options. Curr Opin Obstet Gynecol. 2013;25:456–61. - PubMed
    1. Timor-Tritsch IE, Monteagudo A, Cali G, Vintzileos A, Viscarello R, Al-Khan A, et al. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound Obstet Gynecol. 2014;44:346–53. - PubMed
    1. Society for Maternal-Fetal Medicine (SMFM) Miller R, Gyamfi-Bannerman C. Publications Committee Electronic address: Pubs@smfmorg. Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy. Am J Obstet Gynecol. 2022;227:B9–20. - PubMed
    1. Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brölmann HA, Mol BW, Huirne JA. Why do niches develop in Caesarean uterine scars?Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30:2695–702. - PMC - PubMed