Management and outcomes of caesarean scar pregnancy in medina maternity and children hospital


  • Bahaa Eldin Salama Department of Obstetrics and Gynecology, Maternity and Children Hospital, Medina, Saudi Arabia
  • Mohammed Mufti Hospitality Quality and Patient Safety Department, King Salman bin Abdulaziz Medical City, Medina, Saudi Arabia
  • Rehab Alruwathi Department of Obstetrics and Gynecology, Maternity and Children Hospital, Medina, Saudi Arabia
  • Tarig Yassin Department of Obstetrics and Gynecology, Maternity and Children Hospital, Medina, Saudi Arabia
  • Roqayah Tuker Department of Obstetrics and Gynecology, Maternity and Children Hospital, Medina, Saudi Arabia
  • Hamza Nasser Department of Obstetrics and Gynecology, Maternity and Children Hospital, Medina, Saudi Arabia



Cesarean, SP, Ultrasound, MTX


Undergoing previous cesarean section (CS) can have the possibility for implantation of embryonic sac of any later gestation throughout its scar evolving what was known as a scar pregnancy (SP). The aim of this study to describe the diagnosis, treatment and outcomes of caesarean SP in Medina maternity and children hospital. This a case series study encompassed all patient diagnosed and managed as cesarean SP in Medina maternity and children hospital, Medina (MMCH), Saudi Arabia in the period from January 2020 to January 2021. Demographics, clinical and discharge data were attained from the previous hospital electronic records, nursing notes, anesthesia sheets, operative notes, discharge papers, and outpatient clinic documents. A total of 11 women detected by ultrasound (US) and magnetic resonance imaging (MRI) as SP. The mean age of women was 36±3.8 years. The median number of repeated CS was 2 while the mean gestational age was 50.6±7.8 days. The interval from diagnosis to management ranged from 2 to 9 days with a median of 4 days, and the interval between start treatment and negative Beta human chorionic gonadotropin β-hCG ranged from 21 to 135 days with a median of 62 days. The mean interval from last CS until this pregnancy is 39.7±19.2 months. Systemic methotrexate (MTX) given in a single dose for two patients while nine patients received multiple doses. Local MTX given for six cases. Bleeding as a complication occurred with two out of the eleven patients. MTX was actual treatment for SP, but bigger multicenter randomized-controlled trials involving more cases are essential to validate our conclusions.


Boerma T, Ronsmans C, Melesse DY. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341-8.

Betrán AP, Temmerman M, Kingdon C. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet. 2018;392(10155):1358-68.

Sandall J, Tribe RM, Avery L. Short-term and long-term effects of caesarean section on the health of women and children. Lancet. 2018;392(10155):1349-57.

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 obstetr gynecol. 2012;207(1):14-29.

Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound in obstetrics and gynecology. J Int Society Ultrasound Obstetr Gynecol. 2000;16(6):592-3.

Herman A, Weinraub Z, Avrech O, Maymon R, Ron-El R, Bukovsky Y. Follow up and outcome of isthmic pregnancy located in a previous caesarean section scar. Bri J obstetr gynaecol. 1995;102(10):839-41.

Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarian section scar. Fertility and sterility. 1997;67(2):398-400.

Seow KM, Hwang JL, Tsai YL, Huang LW, Lin YH, Hsieh BC. Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar pregnancy. Acta obstetric gynecol Scandinavica. 2004;83(12):1167-72.

Shufaro Y, Nadjari M. Implantation of a gestational sac in a cesarean section scar. Fertility sterility. 2001;75(6):1217.

Sadeghi H, Rutherford T, Rackow BW. Cesarean scar ectopic pregnancy: case series and review of the literature. Am J perinatol. 2010;27(2):111-20.

Lian F, Wang Y, Chen W. Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern. Cardiovascular interventional radiol. 2012;35(2):286-91.

Maymon R, Halperin R, Mendlovic S. Ectopic pregnancies in Caesarean section scars: the 8 year experience of one medical centre. Human reproduction. 2004;19(2):278-84.

Veridiano NP, Lopes J, Ohm HK, Tancer ML. Placenta percreta as a cause of uterine perforation during abortion. A case report. J reproductive med. 1986;31(11):1049-50.

Fylstra DL. Ectopic pregnancy within a cesarean scar: a review. Obstetric gynecol survey. 2002;57(8):537-43.

Seow KM, Hwang JL, Tsai YL. Ultrasound diagnosis of a pregnancy in a Cesarean section scar. Ultrasound in obstetrics and gynecology. J Int Society Ultrasound Obstet Gynecol. 2001;18(5):547-9.

Lai YM, Lee JD, Lee CL, Chen TC, Soong YK. An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar. Acta obstetric gynecol Scandinavica. 1995;74(7):573-6.

Hung TH, Shau WY, Hsieh TT, Hsu JJ, Soong YK, Jeng CJ. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Human reproduction. 1998;13(9):2636-42.

Ayoubi JM, Fanchin R, Meddoun M, Fernandez H, Pons JC. Conservative treatment of complicated cesarean scar pregnancy. Acta obstetric gynecol Scandinavica. 2001;80(5):469-70.

Ravhon A, Ben-Chetrit A, Rabinowitz R, Neuman M, Beller U. Successful methotrexate treatment of a viable pregnancy within a thin uterine scar. Bri j obstetr gynaecol. 1997;104(5):628-9.

Nawroth F, Foth D, Wilhelm L, Schmidt T, Warm M, Römer T. Conservative treatment of ectopic pregnancy in a cesarean section scar with methotrexate: a case report. Eur j obstetr gynecol reprod biol. 2001;99(1):135-7.

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

Wu X, Zhang X, Zhu J, Di W. Caesarean scar pregnancy: comparative efficacy and safety of treatment by uterine artery chemoembolization and systemic methotrexate injection. Eur J obstetr gynecol reprod biol, 2012;161(1):75-9.

Yang XY, Yu H, Li KM, Chu YX, Zheng A. Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy. Int J obstetr gynaecol. 2010;117(8):990-96.

Chen F-Y, Torng P-L, Huang S-C, Chow S-N. Ectopic Pregnancy Within a Cesarean Section Scar: Report of Two Cases. Taiwanese J Obstetr Gynecol. 2004;43(1):38-41.






Case Series