Avoiding the knife: individualized management of cesarean scar pregnancy – insights from two cases

Abstract

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy implanted within a previous caesarean section scar. Early diagnosis is crucial due to risk of uterine rupture and severe hemorrhage. We report two cases of CSP diagnosed in the first trimester and successfully managed with conservative medical therapy. Both patients were hemodynamically stable and treated with methotrexate-based protocols and mifepristone-misoprostol with close follow-up and serial β-hCG monitoring. One case required dilatation and curettage while other case did not require it. But more importantly, neither of them required any major surgery. Early diagnosis using transvaginal ultrasonography allows successful conservative management in selected cases, avoiding major surgical intervention and preserving fertility.