Caesarean scar ectopic pregnancy: A single centre case series

Objective:  To examine the characteristics, management and outcomes of 13 caesarean scar pregnancies (CSPs) at a single tertiary obstetric centre over a five-year period.
Methods:  Retrospective cohort study. Cases were identified from interrogation of the institutional database with patient characteristics, management and outcome data extracted from the medical record chart and ultrasound image review.
Results:  Thirteen cases of CSP were identified from 2002–2007. Median maternal age was 34 years (interquartile range (IQR) 32.2, 35.2) with a median parity of 2 (IQR 1, 3). In nine of 13 (69%) cases there was one prior caesarean section and ≥ 2 in four of 13 (31%). The median gestation at diagnosis was 6.8 weeks (range 5.5–11.5). Vaginal bleeding was the most common presenting symptom (nine of 13 cases). The final diagnosis was made by ultrasound in 11 of 13 cases (84.6%) but the diagnosis was delayed in seven of 13 cases, including four that had an earlier ultrasound assessment. Treatment was with systemic methotrexate in seven cases with five (71.4%) requiring no further intervention. One case received intragestational sac and systemic methotrexate with a delayed hysterectomy as a result of molar complications. Two cases were treated with uncomplicated curettage and three by hysterectomy. Four women are known to have had pregnancies following the CSP.
Conclusions:  The diagnosis of CSP can be challenging, and awareness of this condition is needed, particularly as the incidence is increasing. There does not appear to be a clear association between number of prior caesarean deliveries and CSPs. No consistent management strategy was evident in our series, being based predominantly on patient factors and consultant resources rather than CSP features.