剖宫产瘢痕妊娠的诊断与治疗进展

剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）是指妊娠囊种植在剖宫产术后子宫瘢痕部位,其外周被子宫肌层和纤维组织包围,是一种罕见的异位妊娠。其可以导致阴道大出血、子宫破裂、孕产妇生育能力丧失,甚至死亡。近年来,CSP的发病率有逐年上升的趋势,但发病机制尚不明确。因此,做好CSP的早诊断、早治疗显得尤为重要。超声检查能够辅助医务人员做到CSP的早诊断,但是尚缺乏统一的标准。而CSP的治疗,也尚未统一规范化。综述CSP的诊断与治疗进展。     

剖宫产术后子宫瘢痕妊娠的诊治决策

目的：探讨剖宫产术后子宫瘢痕妊娠（cesaren scar pregnancy,CSP）的诊治决策。方法：选择解放军总医院2007年1月-2012年8月因CSP住院治疗的患者51例,统计患者剖宫产指征、次数、术后恢复情况及发病时间。针对患者具体病情采用清官、子宫动脉栓塞、宫腹腔镜诊治、经阴道病灶切除及子宫切除等方式治疗。结果：所有病例均经超声诊断。患病距上次剖宫产时间5-147个月,平均（60．5±9．5）个月。妊娠2-6次,除10例（19．61％）为临产后剖宫产外,41例（80．39％）为未临产选择性子宫下段横切口剖宫产。48例患者经保守治疗成功：其中8例超声监测下单纯清官、19例子宫动脉栓塞后清宫、8例在腹腔镜或宫、腹腔镜联合监测下清官、11例行宫颈局部注射或深部肌内注射甲氨蝶呤、2例经阴道行子宫前壁修补术,另3例切除子宫（其中1例死亡）。结论：CSP属高危妊娠,早期诊断、谨慎处理至关重要。超声是诊断CSP的有效方法。     

剖宫产切口瘢痕部位妊娠的研究进展

剖宫产切口瘢痕部位妊娠（cesarean section scar pregnancy,CSP）是罕见的异位妊娠,是剖宫产远期并发症之一。近年随着剖宫产率的上升,其发病率也在不断攀升。CSP是指妊娠囊种植在原子宫下段剖宫产切口瘢痕部位的妊娠,可发生子宫破裂、大量出血,危及妊娠妇女生命或因此丧失生育能力。高度警惕CSP的发生并应用清晰度较高的B型超声可协助早期诊断。治疗方法包括局部或全身应用甲氨蝶呤（MTX）,手术治疗包括单纯性刮宫、腹腔镜、宫腔镜辅助手术、子宫动脉栓塞术以及子宫切除术。应进行综合分析,做出适合于具体患者的治疗措施。如处理得当,预后较好。综述CSP的研究进展。     

腹腔镜在治疗剖宫产后子宫瘢痕妊娠中的应用

目的:探讨腹腔镜在治疗剖宫产后子宫瘢痕妊娠(CSP)中的应用价值.方法:回顾分析2008年3月至2011年5月经腹腔镜诊治7例CSP患者的临床资料.结果:7例患者均腹腔镜下完成手术,治愈并保留子宫,手术成功率100％,平均手术时间85.7±17.2分钟,平均手术出血量202.9±270ml,无中转开腹.6例同时行瘢痕修补,术后血人绒毛膜促性腺激素(β-HCG)降至100 U/L以下时间平均14.6±5.2天,超声显示子宫恢复正常时间平均21.7±30.2天,1例未同时行瘢痕修补的患者,超声显示3个月后子宫恢复正常.结论:腹腔镜在明确CSP诊断的同时还能在阻断双侧子宫动脉后行妊娠物清除和瘢痕修补,是治疗CSP的理想方法.     

剖宫产瘢痕妊娠研究进展

剖宫产瘢痕妊娠（CSP）是一种特殊类型的异位妊娠,随着剖宫产率的增加,其发病率也在逐年增高。如不能对其进行及时诊治,将会出现大量出血、甚至子宫破裂等并发症,严重威胁患者生命。目前,CSP的发病机制、诊断及治疗尚无统一标准,对其发病机制的研究有助于CSP的预防,早期诊断及合理的治疗方法可以避免严重的并发症发生。     

剖宫产术后子宫瘢痕妊娠71例临床分析

目的:探讨剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的临床表现、诊断、治疗及预后。方法:回顾性分析71例CSP患者的临床表现、诊断、治疗及预后的临床资料。结果:71例CSP患者均经阴道彩色超声确诊,其中58例有临床表现。63例行子宫动脉栓塞术(UAE)+甲氨蝶呤(MTX)灌注术,9例行UAE。术后24~48 h,34例B超引导下行清宫术,29例宫腔镜下行清宫术,8例行腹腔镜手术;术后定期监测血人绒毛膜促性腺激素(hCG)至正常。71例均痊愈,月经平均复潮时间40.4±9.0(20~83)d。结论:盆腔彩色超声在CSP诊断中有重要意义,UAE+MTX灌注术+宫腔镜下清宫术(或腹腔镜手术)是治疗CSP的有效方法。     

腹腔镜在子宫瘢痕妊娠中的应用

随着剖宫产的增加,剖宫产术后子宫瘢痕妊娠（cesarean scar pregnancy,CSP）的发生率随着增加。其发生是因为剖宫产时子宫下段瘢痕愈合不良所致,随着经阴道超声诊断准确性的不断提高,目前CSP的诊断已不是临床难题。但在治疗方案选择上国际尚无统一标准,因为子宫CSP患者病情及就诊时情况面临的个体差异非常大,方案选择应当个体化,而个体化方案的选择缺乏规范化标准,是临床面临的主要难题。当前普遍认为,对于有手术指征者,尽早手术既可去除病灶,避免发生子宫破裂、大出血等危及生命的并发症甚至切除子宫而丧失生育能力,又可修复子宫瘢痕缺陷,降低再次妊娠的风险。腹腔镜在中国已经普及,许多医院都有腹腔镜手术的设备及技术,手术安全性及可行性无需置疑。综述近年腹腔镜在剖宫产术后子宫CSP中应用的相关报道,腹腔镜手术是手术患者的首选治疗措施,可将对患者生活质量的影响降至最低。但手术风险必须充分评估,由技术娴熟的医生主刀操作,术前必须准备好应对出血的措施,必要时转为子宫切除,术中要仔细检查有无膀胱损伤。     

Asymptomatic uterine rupture of a cornual pregnancy in the third trimester: a case report

BACKGROUND: Reports of cornual pregnancy persisting until fetal viability and of ultrasound diagnosis of asymptomatic uterine rupture are rare. CASE: A 24-year-old woman, gravida 6, para 5, presented for initial ultrasound evaluation at 28 5/7 weeks' gestation after registering late for prenatal care. Her history included 2 prior cesarean deliveries. Obstetric ultrasound evaluation revealed a clinically silent uterine rupture with a live fetus. The site of rupture was suspected to be the prior uterine scar. After completion of a course of antenatal corticosteroids, the patient underwent exploratory laparotomy, abdominal delivery of a live, male neonate, hysterectomy and appendectomy. The patient experienced an unremarkable postoperative course and was discharged on postoperative day 4. The infant was discharged on hospital day 83 with chronic lung disease, stage 1 retinopathy of prematurity, atrial septal defect and a right clubfoot; there were no additional findings at the 4-month follow-up. Pathologic examination demonstrated cornual implantation with subsequent uterine rupture. CONCLUSION: This case demonstrates the importance of maintaining a suspicion for ectopic pregnancy at advanced gestational ages and for uterine rupture even in the absence of symptoms. The case also illustrates that fetal survival can occur in cornual pregnancy.     

29例剖宫产瘢痕妊娠诊断及治疗方式的探讨

目的探讨子宫下段剖宫产瘢痕妊娠的临床发病特点、诊断标准及其治疗策略的选择,为临床合理诊治提供依据。方法收集2007年1月至2010年6月华中科技大学同济医学院附属同济医院妇科病房收治的29例子宫下段剖宫产瘢痕妊娠患者的临床资料,分析其临床发病特点、诊断及其治疗过程。结果子宫下段剖宫产瘢痕妊娠发病率为1.43/1000次妊娠。29例患者均有停经,27例(93.10%)患者有不同程度的阴道出血,其中19例(65.52%)患者出血总量超过500ml,5例(17.24%)患者因失血过多致失血性休克,26例(89.66%)患者血β-hCG(14.03～200000U/L)水平升高。29例均由盆腔三维彩色多普勒超声检测诊断,诊断准确率100%。治疗方法中,药物治疗23例(成功3例,成功率10.34%),清宫术7例,双侧髂内动脉栓塞或结扎21例,剖宫产瘢痕妊娠病灶切除术18例。治疗后监测血β-hCG水平恢复正常时间为2～7周,平均(4.01±0.23)周,无严重不良反应。结论子宫下段剖宫产瘢痕妊娠的治疗方法多样化,其中甲氨蝶呤药物联合双侧髂内动脉结扎和剖宫产瘢痕妊娠病灶切除手术方法出血较少且疗效显著。应争取早期确诊,并及时选择合理的治疗方法。     

腹腔镜在子宫瘢痕部位妊娠处理中的应用

目的探讨腹腔镜在治疗子宫瘢痕部位妊娠(cesarean scar pregnancy,CSP)处理中的应用价值。方法回顾性分析武汉大学中南医院16例CSP患者的临床资料。依超声结果对CSP分型及分级,相应行腹腔镜监测下刮宫术或病灶切除术并缝合修补切口,腹腔镜下双侧子宫动脉阻断术和/或子宫下段Foley水囊压迫法止血。术后随访血β-hCG及月经情况。结果 16例手术均成功。7例选择腹腔镜监测下刮宫术,手术平均出血量(74±23)ml,平均时间(31±15)min,4例同时Foley水囊压迫法止血;9例腹腔镜镜下病灶切除术并缝合修补切口,手术平均出血量(199±35)ml,平均时间(65±25)min,7例行腹腔镜下双侧子宫动脉阻断术止血,其中2例需同时行Foley水囊压迫法止血。16例患者病理结果均符合CSP。住院日3～7d,术后监测血β-hCG,4周内均降至正常。术后4～9周月经恢复来潮,月经规律。结论彩色超声对CSP治疗方案有指导意义。腹腔镜下根据子宫下段切口瘢痕处浆膜层、肌层情况选择个体化治疗,可有效清除病灶并快速止血,是目前可选择的安全有效的治疗方法。     

Successful Laparoscopic Surgical Removal of a Caesarean Scar Pregnancy (CSP) Using Temporary Uterine Artery Ligation

Study ObjectiveTo demonstrate a laparoscopic technique to remove a scar pregnancy.DesignStepwise demonstration of the surgical technique.SettingSanta Croce and Carle Hospital, Cuneo.InterventionPatient B.B. is a woman referred to our center for a suspected cesarean scar pregnancy (CSP) at 9 weeks gestation. CSP occurs approximately in 6% of all ectopic pregnancies. The estimated incidence is reported to be 1:1800 to 1:2500 in cesarean deliveries. Depending on its location, CSP can be categorized as either type 1, if the growth is in the uterine cavity, or type 2, if it expands toward the bladder and the abdominal cavity. If inadequately managed, it can lead to severe complications; most of them are hemorrhagic and can threaten the woman's life. There are several therapeutic approaches: local excision seems to be the most effective choice in type 2 CSP. In expert hands, the laparoscopic approach is perhaps the best surgical choice as tissue dissection, electrosurgical hemostasis, and vascular control can be effectively managed with minimal invasive access. Because severe intraoperative bleeding can occur, retroperitoneal vascular control is mandatory in this surgery. In type 1 CSP curettage, aspiration or hysteroscopic approach can be considered if the CSP is of small dimensions. A hysteroscopic approach can also be helpful in type 2 CSP during the laparoscopic removal, as intrauterine guidance.A potassium chloride local injection can be considered in a preoperative stage in the presence of a fetal heart rate. The systemic administration of methotrexate is usually ineffective as single agent, but it can be useful if administered as adjuvant therapy.Uterine artery embolization can be useful in an emergency setting to manage severe bleeding, but it can lead to complications in subsequent pregnancies and, more rarely, to premature ovarian failure. Considering poor bleeding at presentation, feasible dimensions, and the woman's desire for future pregnancy, ultrasound-guided aspiration and curettage was attempted. Because endouterine removal was incomplete, methotrexate injection was proposed as adjuvant therapy, but the administration was postponed as the patient tested positive for coronavirus disease 2019. A month later, beta-human chorionic gonadotropin level dropped from over 16 000 to 271 mU/mL, so an ultrasound and biochemical follow-up was performed. A month later, despite a low beta-human chorionic gonadotropin value, an increase in dimensions was observed at ultrasound, so surgical laparoscopic removal was offered.In this video article, laparoscopic removal of scar pregnancy is discussed in the following surgical steps:(1) Temporary closure of uterine arteries at the origin, using removable clips.(2) Retroperitoneal dissection to safely manage the scar pregnancy.(3) Dissection of the myometrial–pregnancy interface.(4) Double layer suture on the anterior uterine wall.ConclusionLaparoscopic surgical management is a very effective surgical approach to remove CSP. Knowledge of retroperitoneal dissection and vascular control is necessary to carry out this surgical intervention safely and effectively.     

子宫动脉栓塞术治疗剖宫产瘢痕部位妊娠相关问题探讨

目的:探讨子宫动脉栓塞术(UAE)辅助治疗剖宫产术后子宫瘢痕部位妊娠(CSP)的临床效果及相关问题处理对策。方法:51例CSP病例,扩刮宫术(D&C)前采用明胶海绵进行UAE,术后观察终止妊娠术中出血量、术后并发症、血hCG下降情况、超声检测子宫异常妊娠局部情况及费用等。结果:38例UAE后行扩刮宫术(A组),10例行UAE+D&C术前已应用药物治疗(天花粉3例,氨甲喋呤7例)(B组)。3例患者直接扩刮宫术时因大出血行子宫腔填塞术,同时施行紧急UAE(C组)。血β-hCG恢复正常值时间、术中出血量A、B组间均无差异;A组住院时间和治疗总费用远低于B组,P<0.01。结论:终止剖宫产瘢痕部位妊娠术前采用UAE辅助治疗,具有疗效确切、安全、住院时间短等特点,有条件的医院可选择先行UAE再刮宫治疗方案。     

Treatment of viable cesarean scar ectopic pregnancy with suction curettage.

OBJECTIVE: Pregnancy in previous cesarean scar is the rarest form of ectopic pregnancy. All reported cases in the literature that were treated with uterine curettage either become unsuccessful or complicated. We aimed to present a case of cesarean scar ectopic pregnancy that was successfully treated with suction curettage without any additional therapy. CASE: A 32-year-old asymptomatic woman, gravida 2, para 1 was referred to our hospital with the possible diagnosis of cervical ectopic pregnancy. Transvaginal and transabdominal sonographic examination revealed the diagnosis of viable ectopic pregnancy in a previous cesarean scar. Suction curettage with carman canulles was performed under transabdominal ultrasonographic guidance. beta-hCG decreased progressively postoperatively. CONCLUSION: Suction curettage under ultrasonography guidance can be used in termination of selected cases (early diagnosed, without symptoms that necessitates emergency intervention) of cesarean scar pregnancy.     

剖宫产瘢痕妊娠27例诊治分析

目的探讨剖宫产瘢痕妊娠(CSP)的合理诊治方法。 方法回顾性分析2005年1月至2011年9月中山大学孙逸仙纪念医院收治的27例CSP患者的临床资料,对其病史、临床表现、辅助检查、诊断、处理及结局等进行总结分析。外院转入组与我院首次接诊组患者的孕次、产次、距末次剖宫产时间、停经天数、入院时HCG值的比较应用t检验,两组的开腹手术比例、包块型比例的比较应用卡方检验。 结果27例患者中外院转入者13例,均在外院行药流或清宫术后,因反复阴道流血或突发性大量阴道流血转入我院;首次就诊我院者14例。我院首次接诊组与外院转入组比较,停经天数(57.1±17.8)d与(83.5±28.4)d,t＝2.910;开腹手术比例(1例与7例),χ²＝7.050;超声表现为包块型的比例(1例与13例),χ²＝23.280;P值均<0.05。27例中行宫腔镜电切术7例,其中2例因术中出血较多,转为开腹手术。开腹行病灶切除加修补术8例,行清宫术9例,其中单纯行清宫2例,2例术中出现大出血而紧急子宫动脉化疗栓塞术(UACE),其他5例则用甲氨蝶呤(MTX)治疗或UACE后行清宫术。行UACE 14例,其中13例UACE联合清宫术或宫腔镜或术后MTX治疗。单纯MTX药物治疗2例。27例均治愈,无子宫切除病例。 结论剖宫产瘢痕妊娠较少见,临床容易误诊,治疗应根据患者血HCG水平、病灶大小、部位、表面肌层厚度、血流、阴道流血情况等进行综合评价,选择个体化治疗方案,必要时几种治疗方法联合应用。     

Robotic CSP Resection and Hysterotomy Repair

Study ObjectiveTo demonstrate a technique for the robot-assisted laparoscopic surgical management of cesarean section scar ectopic pregnancy (CSP) and hysterotomy repair.DesignStep-by-step presentation of the procedure using video.SettingCSP is a rare form of ectopic pregnancy. The incidence of CSP has been increasing with rising cesarean deliveries and is estimated to range from 1 of 1800 to 1 of 2500 of all pregnancies. Various management of CSP have been used such as systemic or local methotrexate, surgical resection, and uterine artery chemoembolization. Exogenic or deep CSP occurs when the gestational sac is deeply embedded in the scar and the surrounding myometrium and grows toward the bladder. Surgical resection of this type of CSP seemed reasonable, which could shorten hospitalization and follow-up time and reduce the failure rate of treatment. For its magnification of the 3-dimensional laparoscope, flexibility endo-wrist, and stabilization of instruments within the surgical field, robot-assisted laparoscopic resection can be performed to manage this type of complex procedure.InterventionsIn this video, we describe our technique for robot-assisted laparoscopic management of a CSP and a hysterotomy repair. We present the case of a 34-year-old gravida 2 para 1 woman with the finding of a 7-week pregnancy embedded in the cesarean section scar. The patient had undergone 1 previous uncomplicated cesarean section at term. On presentation, her β-human chorionic gonadotropin level was 9212 IU/L. In this case, the gestational sac was deeply embedded in the scar and the surrounding myometrium and was growing toward the bladder. A decision was made to proceed with surgical treatment in the form of a robot-assisted laparoscopic resection of the ectopic pregnancy and the hysterotomy repair. The surgery was uneventful, and the patient was discharged home within 48 hours of her procedure. No residual scar defect was visible on follow-up ultrasonography 1 month after surgery. Forty days after surgery, the patient had resumed normal menstruation and was followed up for 3 years with regular menstruation and no abnormal uterine bleeding.ConclusionRobot-assisted laparoscopic excision of CSP and hysterotomy repair is an effective procedure for the management of this increasingly more common condition. The use of a cervix dilator and robot-assisted laparoscopic suturing can prevent hemorrhage and peripheral tissue damage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect.     

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

Study ObjectiveTo demonstrate laparoscopic management of a molar scar ectopic pregnancy.DesignStepwise demonstration of the technique with narrated video footage.SettingCesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively.InterventionsTotal laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layersConclusionThere are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].     

Laparoscopic management of an ectopic pregnancy in a lower segment cesarean section scar: a review and case report

Implantation of a pregnancy within the scar of a previous cesarean delivery is the rarest of ectopic pregnancy locations, with only 32 cases reported in the English-language medical literature. A 28-year-old woman was admitted to our institution with a suspected ectopic pregnancy located in the scar from a previous cesarean section. Ultrasound revealed a well-encapsulated, bulging mass with a gestational sac within the anterior uterine isthmus in the site of an old cesarean delivery scar. Laparoscopy was performed to confirm the diagnosis, and the gestational products also were removed laparoscopically. The defect in the uterus was then repaired by suturing. Total operative time was 120 minutes, blood loss was limited, and no transfusion was needed. Laparoscopy may be a reasonable alternative to laparotomy for an unruptured ectopic pregnancy in a cesarean scar.     

21例剖宫产子宫切口瘢痕部位妊娠临床病例分析

目的　探讨剖宫产子宫切口瘢痕部位妊娠(cesarean scar pregnancy,CSP)的早期诊断和治疗. 方法　收集1995年11月至2005年11月共十年间复旦大学附属妇产科医院收治的所有病例的临床资料,共21例.根据超声检查,血hCG的水平确诊,分析其发病年龄、孕周、症状、治疗方式及预后. 结果 患者平均年龄33岁(26～44岁),均为1次剖宫产术史,此次妊娠距离前次剖宫产的时间为8个月～18年,平均孕龄为47 d(36～70 d).16例(76.2%)患者主诉阴道流血,其中6例(28.6%)伴有腹痛.治疗方式包括单独或联合应用氨甲蝶呤(methotrexate,MTX)全身或局部给药、子宫动脉栓塞术、介入化疗、宫腔镜下病灶切除术、开腹子宫病灶切除术、刮宫术等.所有病例均保守治疗成功,保留了生育功能.平均住院天数为22 d(9～39 d). 结论 CSP的发病呈上升趋势,早期发现多可保守治疗.MTX能有效终止妊娠,介入化疗和子宫动脉栓塞术联合刮宫术是有效的治疗手段.     

腹腔镜双侧髂内动脉临时阻断下子宫修补联合宫腔镜清宫术在Ⅲ型剖宫产瘢痕部位妊娠中的应用

目的 探讨腹腔镜下髂内动脉可逆性结扎及子宫修补联合宫腔镜下清宫术在Ⅲ型剖宫产瘢痕部位妊娠术中的疗效和安全性.方法 回顾性分析2017年11月～2020年11月广州医科大学附属广州市妇女儿童医疗中心收治的剖宫产瘢痕部位妊娠患者135例,其中Ⅲ型患者32例,根据术前处理措施不同,分为髂内动脉临时阻断组(21例)和子宫动脉栓...     

Cesarean Scar Pregnancy: Imaging and Treatment with Conservative Surgery

Background: Pregnancy in a cesarean scar represents a rare type of secondary abdominal pregnancy. Early diagnosis can be challenging and optimal treatment is unknown.Case: A 21-year-old woman presented for an abortion at 8 weeks’ gestation. A cesarean delivery had been performed 5 months earlier. Suspecting a cervical pregnancy, her physician referred her to us, and an 8-week cesarean scar gestation was diagnosed and then confirmed by serial sonograms, cystoscopy, and magnetic resonance imaging. The patient elected pregnancy termination, which was accomplished by hysterotomy with uterine preservation followed by intramuscular methotrexate.Conclusion: We report a case of cesarean scar pregnancy treated surgically with uterine preservation. This approach should be considered when cesarean scar ectopic pregnancy is diagnosed.