Cesarean Scar Pregnancy
Cesarean Scar Pregnancy
A Cesarean Scar Pregnancy is an ectopic pregnancy in which the gestational sac implants within, or immediately adjacent to, the fibrous defect of a previous cesarean delivery scar in the lower uterine segment rather than in the normal endometrial lining of the uterus. This abnormal implantation can progress but carries high risks, including severe hemorrhage, uterine rupture, and development of placenta accreta spectrum disorders if the pregnancy continues.
The condition is sometimes called cesarean scar ectopic pregnancy and is increasingly identified due to rising cesarean rates and improved early ultrasound detection.
Diagnosis
Typical first-trimester transvaginal ultrasound findings include an empty uterine cavity and endocervical canal, a gestational sac embedded at the level of the anterior lower uterine segment scar, a thin or absent myometrium between the sac and bladder, and prominent peritrophoblastic flow on Doppler.
Early diagnosis (before 9 weeks) improves detection accuracy, while later growth toward the fundus can obscure recognition of low implantation despite ongoing placental attachment to the scar niche.
Because the scar tissue is weaker than intact myometrium, implantation at this site increases risks of hemorrhage, uterine rupture, and a path toward placenta accreta spectrum as the pregnancy or placenta invades deeply.
Expectant continuation has been associated with high morbidity; expert societies advise against continuation due to maternal risk, though rare livebirths have been reported when early complications do not occur.
Frequently Asked Questions
What is a cesarean scar pregnancy?
A cesarean scar pregnancy is an ectopic pregnancy in which the gestational sac implants within or immediately adjacent to the fibrous defect of a prior cesarean delivery scar in the lower uterine segment, rather than in the normal uterine cavity.
How is it diagnosed?
Diagnosis is usually made in the first trimester with transvaginal ultrasound showing an empty uterine cavity and cervix, a gestational sac embedded at the anterior lower uterine segment scar, very thin or absent myometrium between the sac and the bladder, and increased peritrophoblastic Doppler flow; early scanning improves accuracy before the sac migrates cranially while remaining attached to the scar niche.
What are the treatment options?
Management is individualized and may include medical therapy, image‑guided or surgical evacuation, or uterine‑sparing techniques in early gestation; expert societies generally advise against continuing the pregnancy due to high maternal risk, though counseling should cover benefits, risks, and local resources for urgent care if bleeding occurs.
What about future fertility and recurrence?
Subsequent intrauterine pregnancy is possible after treatment, but there is a measurable risk of recurrence and pregnancy complications such as miscarriage, preterm birth, and placenta accreta spectrum; early first‑trimester evaluation in future pregnancies is recommended to confirm safe implantation.
Why is it dangerous?
Implantation in weak scar tissue increases risks of severe hemorrhage, uterine rupture, and progression to placenta accreta spectrum if the pregnancy continues, which can necessitate transfusion, complex surgery, or hysterectomy and may be life‑threatening without timely management.
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