Caesarean scar pregnancy – an ongoing therapeutic challenge. Case series and literature review

Abstract

Introduction. Caesarean scar pregnancy (CSP) is a life-threatening and iatrogenic disease due to the rising number of caesarean sections (CS) in the last decades. The most practical and effective technique for the early diagnosis of CSP is transvaginal ultrasound (TVUS), complemented with color Doppler. The optimal approach is yet to be standardized. Method­ology. This is a monocentric, prospective, observational study performed in the one tertiary hospital – the prenatal unit of the County Emergency Clinical Hospital Craiova and Medgin/GinEcho Clinic Craiova. The study enrolled four patients, based on specific inclusion criteria: diagnosis of CSP using transvaginal ultrasound. We described the particularities of the conservative therapeutic approach in those cases correlated with the data from the literature. Results. Four CSP cases were identified during 2022-2023 at the standard dating scan. The treatment approaches involved conservative local methotrexate associated with various procedures – systemic methotrexate, embolization, Folley catheter compression and eventually aspiration, leading to a decrease of βHCG levels and to favorable ultrasound findings of pregnancy involution, indicating positive outcomes. Conclusions. Caesarean scar pregnancy is an increasing pathology worldwide. The management of CSP represents a challenge that should be individualized and sometimes assessed by a multidisciplinary team for the safest therapeutic option.