Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 16 , ISSUE 1 ( January-February, 2024 ) > List of Articles


Successful Management of Cesarean Scar Pregnancy in a Tertiary Care Hospital in North India: A Case Series

Shivani Verma, Neha Bharti, Saritha Shamsunder

Keywords : Beta human chorionic gonadotrophin, Case series, Cesarean delivery, Cesarean-section, Cesarean scar ectopic pregnancy, Cesarean scar pregnancy, Early pregnancy methotrexate, Transvaginal ultrasonography, Uterine artery embolization, Vaginal bleeding in pregnancy

Citation Information : Verma S, Bharti N, Shamsunder S. Successful Management of Cesarean Scar Pregnancy in a Tertiary Care Hospital in North India: A Case Series. J South Asian Feder Obs Gynae 2024; 16 (1):41-44.

DOI: 10.5005/jp-journals-10006-2330

License: CC BY-NC 4.0

Published Online: 10-01-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: The incidence of cesarean scar pregnancy (CSP) varies from 1/1,800 to 1/2,500 of all pregnancies, which comprises almost six percent of all ectopic pregnancies, in patients with at least one previous cesarean section, and it has increased due to a rise in the number of cesarean deliveries and early detection due to better imaging modalities. Case description: In this case series, three women with early pregnancy presented to the emergency room at our hospital with complaints of lower abdominal pain and spotting or bleeding per vaginum. Diagnosis of CSP was made after performing a transvaginal ultrasound (TVUS) and CSP was successfully managed using systemic methotrexate (MTX) and uterine artery embolization (UAE) in one case and instillation of intracardiac potassium chloride (KCl) along with injecting MTX in the gestational sac in two cases. Beta human Chorionic Gonadotrophin (β-hCG) was measured every week for follow-up until negative. Conclusion: Cesarean scar pregnancy was managed using different modalities depending on the presenting complaints of the woman, clinical features, imaging, and the presence of cardiac activity. Clinical significance: Early detection and timely interventions in CSP are associated with reduced maternal morbidity and mortality.

  1. Clark EAS, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol 2011;205(6 Suppl): S2–S10. DOI: 10.1016/j.ajog.2011.09.028.
  2. Gonzalez N, Tulandi T. Cesarean scar pregnancy: A systematic review. J Minim Invasive Gynecol 2017;24(5):731–738. DOI: 10.1016/j.jmig.2017.02.020.
  3. Uludag SZ, Kutuk MS, Ak M, et al. Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: Time to change conventional treatment and follow-up protocols. Eur J Obstet Gynecol Reprod Biol 2016;206:131–135. DOI: 10.1016/j.ejogrb.2016.09.010.
  4. Alammari R, Thibodeau R, Harmanli O. Vaginal hysterectomy for the treatment of cervical ectopic pregnancy. Obstet Gynecol 2017;129(1):63–65. DOI: 10.1097/AOG.0000000000001782.
  5. Timor-Tritsch IE, Monteagudo A, Santos R, et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstetr Gynecol 2012;207(1):44e1–44e13. DOI: 10.1016/j.ajog.2012.04.018.
  6. Guo J, Yu J, Zhang Q, et al. Clinical efficacy and safety of uterine artery embolization versus laparoscopic cesarean scar pregnancy debridement surgery in the treatment of cesarean scar pregnancy. Med Sci Monit 2018;24:4659–4666. DOI: 10.12659/MSM.907404.
  7. Junaid D, Chaudhry S, Usman M, et al. Caesarean scar ectopic pregnancy: A case series. Pak J Med Dent 2018;7(3):4. DOI:
  8. Pristavu A, Vinturache A, Mihalceanu E, et al. Combination of medical and surgical management in the successful treatment of cesarean scar pregnancy: A case report series. BMC Pregnancy Childbirth 2020;20(1):1–10. DOI: 10.1186/s12884-020-03237-8.
  9. Bodur S, Özdamar Ö, Kılıç S, et al. The efficacy of the systemic methotrexate treatment in cesarean scar ectopic pregnancy: A quantitative review of English literature. J Obstet Gynaecol 2015;35(3):290–296. DOI: 10.3109/01443615.2014.954101.
  10. Levin G, Zigron R, Dior UP, et al. Conservative management of Caesarean scar pregnancies with systemic multidose methotrexate: Predictors of treatment failure and reproductive outcomes. Reprod Biomed Online 2019;39(5):827–834. DOI: 10.1016/j.rbmo.2019.05.015.
  11. Tam LM, Kotani T, Linh TM, et al. The outcome of cesarean scar pregnancy treated with local methotrexate injection. Nagoya J Med Sci 2020;82(1):15–23. DOI: 10.18999/nagjms.82.1.15.
  12. Lipscomb GH, Givens VM, Meyer NL, et al. Comparison of multidose and single-dose methotrexate protocols for the treatment of ectopic pregnancy. Am J Obstet Gynecol 2005;192(6):1844–1847. DOI: 10.1016/j.ajog.2004.12.061.
  13. Saraj AJ, Wilcox JG, Najmabadi S, et al. Resolution of hormonal markers of ectopic gestation: A randomized trial comparing single-dose intramuscular methotrexate with salpingostomy. Obstet Gynecol 1998;92(6):989–994. DOI: 10.1016/s0029-7844(98)00324-x.
  14. Yamaguchi M, Honda R, Uchino K, et al. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: Efficacy and subsequent fecundity. J Minim Invasive Gynecol 2014;21(5):877–883. DOI: 10.1016/j.jmig.2014.03.024.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.