Cesarean Scar Pregnancy: An Emerging Challenge

The high prevalence of cesarean section is closely related to the increasing number of cesarean scar pregnancies. Ultrasound provides early and accurate diagnosis of an ectopic pregnancy in a cesarean section defect, allowing fertility preservation by using minimally invasive procedures and reducing maternal complications. The sonographic appearances, based on history and clinical symptoms, of a pregnancy implanted into a cesarean scar have to be recognized during routine obstetric practice. Laparoscopy or hysteroscopy management would be considered in early scar pregnancies. Combined systemic and intra-amniotic methotrexate injection also yield high success rates but require serial ultrasound investigations and follow-up with serum beta-hCG in the following weeks.