Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes.

Purpose: Cesarean scar ectopic pregnancy (CSEP) is considered to be quite rare, but the frequency is increasing given the increasing number of cesarean sections being performed, along with increased detection due to widespread use of early endovaginal sonography. The normal sonographic and magnetic resonance findings of this phenomenon will be discussed, including the appearance of complications associated with abnormal placentation, such as the placenta accreta spectrum. Cases of CSEP at our institution will be illustrated, along with clinical presentations and treatment outcomes.

Methods: The study included women who were diagnosed with a CSEP in the first trimester, which was confirmed by ultrasound. The clinical presentations, imaging findings, and treatment outcomes of these pregnancies were recorded.

Results: In our series, treatment ranged from no intervention with fetal demise on short-term follow-up ultrasound to viable near-term deliveries requiring cesarean section, urgent blood products, and emergent surgery. The majority of our cases 75% (15 of 20) underwent successful early first trimester termination by a combination of systemic methotrexate administration, ultrasound-guided injection of embryocidal agents, and/or surgery.

Conclusion: Early imaging recognition and diagnosis of CSEP is critically important to minimize maternal complications, maintain treatment options, and potentially preserve future fertility.