Caesarean scar ectopic pregnancy: current concepts in diagnosis, classification and management – a comprehensive narrative review

Abstract

Caesarean scar ectopic pregnancy (CSEP) is defined as one in which implantation occurs within the myometrial scar of a previous caesarean section. Although uncommon, CSEP is associated with significant maternal morbidity and potentially life-threatening complications. Its incidence has increased substantially over the past two decades because of rising caesarean section rates and improvements in early pregnancy ultrasonography. Presentation of CSEP varies from asymptomatic cases to shock. The condition is associated with severe maternal morbidity, including massive haemorrhage, uterine rupture, placenta accreta spectrum disorders, disseminated intravascular coagulation, hysterectomy, and even maternal mortality if not diagnosed early. The main diagnostic modality for CSEP is transvaginal ultrasonography (TVS) with colour doppler imaging. Early recognition is crucial for timely intervention. Caesarean scar ectopic pregnancy is classified based on implantation pattern, direction of gestational growth, and myometrial thickness. Management remains controversial as there is no universally accepted treatment protocol. Treatment selection depends on hemodynamic status, gestational age, fetal viability, serum beta-human chorionic gonadotropin levels, myometrial thickness, and future fertility desires. This comprehensive narrative review summarizes the current literature on the epidemiology, etiopathogenesis, risk factors, classification, diagnosis, imaging findings, management options, complications, reproductive outcomes, and preventive strategies for caesarean scar ectopic pregnancy. Advances in early imaging and minimally invasive treatment strategies have improved outcomes substantially; however, standardized management guidelines remain lacking.