Management of Cesarean Scar Ectopic Pregnancies: A Retrospective Study and Literature Review

Cesarean scar ectopic pregnancy (CSEP) is localized over the scar of a previous cesarean section. CSEP is a challenging entity, both in terms of diagnosis and management. The clinical presentation of CSEP may vary from asymptomatic patients with positive urine pregnancy tests to acute presentations such as pelvic pain, bleeding per vaginum, uterine rupture, and hemodynamic instability. Cesarean scar ectopic pregnancy is primarily diagnosed by transvaginal ultrasound. We present a series of six cases of CSEPs, their diagnostic approaches, and outcomes. Out of our six cases, four patients underwent intracardiac injection of potassium chloride (KCl) followed by methotrexate instillation into the gestational sac. This led to the successful resolution of cardiac activity and the collapse of the gestational sac. Two patients underwent curettage under ultrasound guidance. All of the patients recovered successfully without any major surgery. The key to diagnosis is the high degree of suspicion of CSEP in cases of previous cesarean deliveries, even in the absence of any symptoms.