Caesarean scar pregnancy: a case report with review of management options

Vandana Rani, Shaveta Jain, Vani Malhotra, Meenakshi B. Chauhan, Sarika Gautam, Smiti Nanda, Neetu Sangwan


Cesarean scar pregnancy is a rare but life-threatening complication. It is the abnormal implantation of gestational sac into myometrium and fibrous scar of previous cesarean section. Its incidence is on rising trend due to increase in rate of cesarean section all over the world. A thirty years old second gravida presented at eight weeks of gestation with complaints of bleeding per vaginum and pain lower abdomen. She was diagnosed as a case of cesarean scar pregnancy (CSP) on ultrasonography and confirmation of diagnosis was done on magnetic resonance imaging. Medical management of scar pregnancy was done successfully with combination of mifepristone and methotrexate. Cesarean scar pregnancy could be catastrophic, if not managed well in time. Management includes both surgical and medical options. Treatment has to be individualized depending on patient’s hemodynamic profile, size of gestational sac, desire for future fertility, compliance for follow up and availability of interventional radiology.


Cesarean scar pregnancy, Cesarean section, Ectopic, Methotrexate, Mifepristone, Serum β-hCG

Full Text:



Rotas M, Habermen S, Levgur M. Caesarean scar ectopic pregnancies: etiology, diagnosis and management. Obstet Gynecol. 2006;107(6):1373-81.

Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Caesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004;23(3):247-53.

Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options. Curr Opin Obstet Gynecol. 2011;23(6):247-53.

Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus- an unusual cause of postabortal haemorrhage: a case report. S Afr Med J. 1978;53:142-3.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accrete. Am J Obstet Gynecol. 1997;177:210-4.

Fait G, Goyert G, Sundareson A, Pickens A Jr. intramural pregnancy with foetal survival: case history and discussion of etiological factors. Obstet Gynecol. 1987;70(3 pt 2):472-4.

Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First trimester diagnosis and management of pregnancies implanted into lower uterine segment caesarean section scar. Ultrasound Obstet Gynecol. 2003;21:220-7.

Godin PA, Bassil S, Donnez J. An ectopic pregnancy developing in a previous caesarean section scar. Fertil Steril. 1997;67:398-400.

Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of caesarean delieveries: placenta accreta and caesarean scar pregnancy-a review. Am J Obstet Gynecol. 2012;207:14-29.

Srinivas M, Raghupathy K, Ndumbe F. Dilemma in the management of caesarean scar pregnancy. Reprod Syst Sex Disord. 2014;3:1.

Shu S, Luo X, Wang Z, Yao Y. Cesarean scar pregnancy treated by curettage and aspiration guided by laparoscopy. Therap Clin Risk Manag. 2015:11.

Einenkel J, Stumpp P, Kosling S, Horn LC, Hockel M. A misdiagnosed case of cesarean scar pregnancy. Arch Gynecol Obstet. 2005;271:178-81.

Fadhlaoui A, Khrouf M, Khemiri K, Nouira K, Chaker A, Zhioua F. Successful conservative treatment of cesarean scar pregnancy with systemically administered methotrexate and subsequent dilatation and curettage: a case report. Case Reports Obstet Gynaecol. 2011;2012:248564:6.

Lee CL, Wang CJ, Chao A. Laparoscopic management of an ectopic pregnancy in a previous cesarean section scar. Hum Reprod. 1999;14(5):1234-6.

Chou YM, Wu D, Wu KY, Lee CL. Hysteroscopic removal of cesarean scar pregnancy after methotrexate treatment failure. Gynecol Minimal Invasive Ther. 2013;2:70-2.

Shen L, Tan A, Zhu H, Guo C, Liu D, Huang W. Bilateral uterine artery chemoembolization with methotrexate for cesarean scar pregnancy. Am J Obstet Gynecol. 2012;207:386:e1-6.

Huanxiao Z, Shuqin C, Hongye J, Hongzhe X, Gang N, Chengkang X, et al. Transvaginal Hysterotomy for cesarean scar pregnancy in 40 consecutive cases. Gynecol Surg. 2015;12:45-51.