Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 14 , ISSUE 2 ( March-April, 2022 ) > List of Articles


Cesarean Scar Pregnancy: Diagnostic and Management Dilemmas in Low-resource Settings

Amrita Chaurasia, Nidhi Sachan, Neeta Varma

Keywords : Abortifacient, Abortions, Cesarean scar pregnancy, Cohort, Laparotomy

Citation Information : Chaurasia A, Sachan N, Varma N. Cesarean Scar Pregnancy: Diagnostic and Management Dilemmas in Low-resource Settings. J South Asian Feder Obs Gynae 2022; 14 (2):166-171.

DOI: 10.5005/jp-journals-10006-2030

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: Cesarean scar pregnancy (CSP) is a rare but catastrophic event. The incidence of cesarean section (CS) is on an increasing trend and hence is the incidence of CSP. Failure to diagnose and initiate prompt management of CSP may lead to uterine rupture, massive hemorrhage, and even maternal death. Methods: This study was conducted as a retrospective cohort study in women presenting to the Department of Obstetrics and Gynecology, MLN Medical College and Saket Maternity Nursing Home, Prayagraj, Uttar Pradesh, between January 2017 and February 2021, in which a final diagnosis of cesarean scar pregnancy was made. Comprehensive clinical, laboratory, and radiological data were collected from medical records of nine CSP cases. An analysis of demographic and clinical features with treatment modalities was done including age, gravidity, parity, number of previous CS, history of dilation and evacuation (D&E), history of abortifacient intake, presenting complaints, serum beta-hCG levels, sonographic features, and requirement for blood transfusion. Results: The mean age of patients with a final diagnosis of CSP was 30 ± 4.5 years. The previous history of D&E in this study was seen in 22% of patients. The majority (67%) of cases had one previous CS. The median duration from the last CS was 2 years. Approximately 55% of the patients had their last CS done without going into labor. History of abortifacient intake in present pregnancy was notably present in 67% of the patients. The mean gestational sac diameter in patients was 15.4 ± 4.0 mm. Mean myometrial thickness between the bladder and gestational sac was 2.2 ± 1.18 mm. Vascularity was mild in three and severe in five cases. The mean serum beta-hCG level at presentation was 39891.6 ± 36,305 mIU/mL. The majority, i.e., five out of nine patients were managed surgically by laparotomy with a wedge excision of the scar and trophoblastic tissue followed by uterine repair. Conclusion: High index of suspicion for the prompt and accurate diagnosis of CSP by both the gynecologist and sonologist is the need of the hour.

PDF Share
  1. Diagnosis and management of ectopic pregnancy: Green-top guideline no. 21. BJOG 2016;123(13):e15–e55. DOI: 10.1111/1471-0528.14189.
  2. Betrán AP, Ye J, Moller AB, et al. The increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. PLoS One 2016;11(2):e0148343. DOI: 10.1371/journal.pone.0148343.
  3. Ash A, Smith A, Maxwell D. Caesarean scar pregnancy. BJOG 2007;114(3):253–263. DOI: 10.1111/j.1471-0528.2006.01237.x.
  4. Maymon R, Halpern R, Mendlovik S, et al. Ectopic pregnancies caesarean section scars: the 8 year experience of one medical centre. Hum Reprod 2004;19(2):278–284. DOI: 10.1093/humrep/deh060.
  5. Pektas M, Bodur S, Dundar O, et al. Systematic review: What is the best first-line approach for caesarean section ectopic pregnancy? Taiwan J Obstet Gynecol 2016;55(2):263–269. DOI: 10.1016/j.tjog.2015.03.009.
  6. Michener C, Dickinson JE. Caesarean scar ectopic pregnancy: a single centre case series. Austr N Z J Obstet Gynaecol 2009;49(5):451–455. DOI: 10.1111/j.1479-828X.2009.01067.x.
  7. Younes G, Goldberg Y, Lavie O, et al. Caesarean scar pregnancy: a case series of diagnosis, treatment, and results. J Diagn Med Sonography 2018;34(6):502–508. DOI: 10.1177/8756479318791155.
  8. Rotas MA, Haberman S, Levgur M. Caesarean scar ectopic pregnancies: etiology, diagnosis and management. Obstet Gynecol 2006;107(6):1373–1381. DOI: 10.1097/01.AOG.0000218690.24494.ce.
  9. Jayram P, Gbemisola O, Konje J et al. Caesarean scar ectopic pregnancy: diagnostic challenges and management options. Obstet Gynaecol 2017;19(1):13–20. DOI: 10.1111/tog.12355.
  10. Patel MA. Scar ectopic pregnancy. J Obstet Gynaecol India 2015;65(6): 372–375. DOI: 10.1007/s13224-015-0817-3.
  11. Asah-Opoku K, Oduro NE, Swarray-Deen A, et al. Diagnostic and management challenges of caesarean scar ectopic pregnancy in a lower middle income country. Case Rep Obstet Gynecol 2019;2019:4257696, 5 pages. DOI: 10.1155/2019/4257696.
  12. Bodur S, Ozdamar O, Kilic S, et al. The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: a quantitative review of English literature. J Obstet Gynaecol 2014;35(3):290–296. DOI: 10.3109/01443615.2014.954101.
  13. Kalampokas E, Boutas I, Panoulis K. Novel medical therapy of caesarean scar pregnancy with a viable embryo combining multidose methotrexate and mifepristone: a case report medicine. Baltimore 2015;94(41):e1697. DOI: 10.1097/MD.0000000000001697.
  14. Seow KM, Huang LW, Lin YH, et al. Caesarean scar pregnancy: issues in management Ultrasound Obstet Gynecol 2004;23:247–253. DOI: 10.1002/uog.974.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.