ABSTRACT
Cesarean scar ectopic pregnancy is becoming increasingly common at tertiary care hospitals
around the world. It is a condition in which the embryo implants within the myometrium
at the site of a previous cesarean hysterotomy, and it can occur in women with only
one prior cesarean delivery. We present four cases of cesarean scar ectopic pregnancy
diagnosed within a 6-month period between 2007 and 2008. Their initial presentations
and management are discussed, followed by a review of the published literature summarizing
both diagnostic and management recommendations.
KEYWORDS
Ectopic pregnancy - cesarean scar ectopic
REFERENCES
1
Goldner T E, Lawson H W, Xia Z, Atrash H K.
Surveillance for ectopic pregnancy—United States, 1970–1989.
MMWR CDC Surveill Summ.
1993;
42(6)
73-85
2
Rotas M A, Haberman S, Levgur M.
Cesarean scar ectopic pregnancies: etiology, diagnosis, and management.
Obstet Gynecol.
2006;
107(6)
1373-1381
3
Einenkel J, Stumpp P, Kosling S, Horn L C, Hockel M.
A misdiagnosed case of caesarean scar pregnancy.
Arch Gynecol Obstet.
2005;
271(2)
178-181
4
Weimin W, Wenqing L.
Effect of early pregnancy on a previous lower segment cesarean section scar.
Int J Gynaecol Obstet.
2002;
77(3)
201-207
5
Jurkovic D, Hillaby K, Woelfer B et al..
First-trimester diagnosis and management of pregnancies implanted into the lower uterine
segment cesarean section scar.
Ultrasound Obstet Gynecol.
2003;
21(3)
220-227
6
McGowan L.
Intramural pregnancy.
JAMA.
1965;
192
637-638
7
Surapaneni K, Silberzweig J E.
Cesarean section scar diverticulum: appearance on hysterosalpingography.
AJR Am J Roentgenol.
2008;
190(4)
870-874
8
Bashiri A, Burstein E, Rosen S et al..
Clinical significance of uterine scar dehiscence in women with previous cesarean delivery:
prevalence and independent risk factors.
J Reprod Med.
2008;
53(1)
8-14
9
Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A.
Ectopic pregnancies in a caesarean scar: review of the medical approach to an iatrogenic
complication.
Hum Reprod Update.
2004;
10(6)
515-523
10
Chuang J, Seow K M, Cheng W C, Tsai Y L, Hwang J L.
Conservative treatment of ectopic pregnancy in a caesarean section scar.
BJOG.
2003;
110(9)
869-870
11
Seow K M, Huang L W, Lin Y H et al..
Cesarean scar pregnancy: issues in management.
Ultrasound Obstet Gynecol.
2004;
23(3)
247-253
12
McKenna D A, Poder L, Goldman M, Goldstein R B.
Role of sonography in the recognition, assessment, and treatment of cesarean scar
ectopic pregnancies.
J Ultrasound Med.
2008;
27(5)
779-783
13
Vial Y, Petignat P, Hohlfeld P.
Pregnancy in a cesarean scar.
Ultrasound Obstet Gynecol.
2000;
16(6)
592-593
14
Chou M M, Hwang J I, Tseng J J, Huang Y F, Ho E S.
Cesarean scar pregnancy: quantitative assessment of uterine neovascularization with
3-dimensional color power Doppler imaging and successful treatment with uterine artery
embolization.
Am J Obstet Gynecol.
2004;
190(3)
866-868
15
Valley M T, Pierce J G, Daniel T B, Kaunitz A M.
Cesarean scar pregnancy: imaging and treatment with conservative surgery.
Obstet Gynecol.
1998;
91(5 Pt 2)
838-840
16
Herman A, Weinraub Z, Avrech O et al..
Follow up and outcome of isthmic pregnancy located in a previous caesarean section
scar.
Br J Obstet Gynaecol.
1995;
102(10)
839-841
17
Holland M G, Bienstock J L.
Recurrent ectopic pregnancy in a cesarean scar.
Obstet Gynecol.
2008;
111(2 Pt 2)
541-545
18
Hsieh B C, Hwang J L, Pan H S et al..
Heterotopic caesarean scar pregnancy combined with intrauterine pregnancy successfully
treated with embryo aspiration for selective embryo reduction: case report.
Hum Reprod.
2004;
19(2)
285-287
19
Hartung J, Meckies J.
Management of a case of uterine scar pregnancy by transabdominal potassium chloride
injection.
Ultrasound Obstet Gynecol.
2003;
21(1)
94-95
20
Hois E L, Hibbeln J F, Alonzo M J, Chen M E, Freimanis M G.
Ectopic pregnancy in a cesarean section scar treated with intramuscular methotrexate
and bilateral uterine artery embolization.
J Clin Ultrasound.
2008;
36(2)
123-127
21
Wang C J, Yuen L T, Chao A S et al..
Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction
curettage.
BJOG.
2005;
112(6)
839-840
22
Wang C J, Yuen L T, Yen C F, Lee C L, Soong Y K.
Three-dimensional power Doppler ultrasound diagnosis and laparoscopic management of
a pregnancy in a previous cesarean scar.
J Laparoendosc Adv Surg Tech A.
2004;
14(6)
399-402
23
Wang Y L, Su T H, Chen H S.
Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section
scar: a review and case report.
J Minim Invasive Gynecol.
2005;
12(1)
73-79
24
Hasegawa J, Ichizuka K, Matsuoka R et al..
Limitations of conservative treatment for repeat cesarean scar pregnancy.
Ultrasound Obstet Gynecol.
2005;
25(3)
310-311
25
Ben Nagi J, Helmy S, Ofili-Yebovi D et al..
Reproductive outcomes of women with a previous history of caesarean scar ectopic pregnancies.
Hum Reprod.
2007;
22(7)
2012-2015
26
Seow K M, Hwang J L, Tsai Y L et al..
Subsequent pregnancy outcome after conservative treatment of a previous cesarean scar
pregnancy.
Acta Obstet Gynecol Scand.
2004;
83(12)
1167-1172
27
Jiao L Z, Zhao J, Wan X R et al..
Diagnosis and treatment of cesarean scar pregnancy.
Chin Med Sci J.
2008;
23(1)
10-15
28
Ben Nagi J, Ofili-Yebovi D, Sawyer E, Aplin J, Jurkovic D.
Successful treatment of a recurrent cesarean scar ectopic pregnancy by surgical repair
of the uterine defect.
Ultrasound Obstet Gynecol.
2006;
28(6)
855-856
29
Piccoli V, Martina M D, Biasioli A et al..
Twin ectopic pregnancy in a previous cesarean scar section and subsequent fertility.
Eur J Obstet Gynecol Reprod Biol.
2008;
136(1)
131-132
30
Lai Y M, Lee J D, Lee C L, Chen T C, Soong Y K.
An ectopic pregnancy embedded in the myometrium of a previous cesarean section scar.
Acta Obstet Gynecol Scand.
1995;
74(7)
573-576
31
Smorgick N, Vaknin Z, Pansky M et al..
Combined local and systemic methotrexate treatment of viable ectopic pregnancy: outcomes
of 31 cases.
J Clin Ultrasound.
2008;
36(9)
545-550
32
Wang Y L, Su T H, Chen H S.
Operative laparoscopy for unruptured ectopic pregnancy in a caesarean scar.
BJOG.
2006;
113(9)
1035-1038
Homayoun SadeghiM.D.
Department of Obstetrics, Gynecology, and Reproductive Sciences
Yale University School of Medicine, 333 Cedar St., New Haven, CT 06519
Email: homayoun99@post.harvard.edu