Rising Incidence of Cesarean Scar Pregnancy: Early Diagnosis and Contemporary Management Strategies - A Narrative Review

Abstract

Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy in which the gestational sac implants within the scar of a previous cesarean section. With rising cesarean delivery rates worldwide, the incidence of CSP is also increasing. Early diagnosis is crucial to reduce maternal morbidity, preserve fertility, and avoid severe complications such as uterine rupture and massive hemorrhage. This review summarizes the current understanding of epidemiology, risk factors, diagnosis, and management of CSP according to contemporary international standards.

Introduction

Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy occurring in the scar of a previous cesarean section, making up about 6% of such cases in affected women. Its incidence is rising alongside increasing cesarean rates. Delayed diagnosis can cause serious complications like heavy bleeding, uterine rupture, and even hysterectomy, making early detection crucial.

This review compiles current knowledge on CSP, including its epidemiology, diagnosis, and management, using recent medical literature and guidelines.

Key risk factors include multiple cesarean sections, prior uterine surgeries, IVF, manual placenta removal, and short gaps between pregnancies. Diagnosis is best made using transvaginal ultrasound, which shows characteristic findings such as an empty uterus and a gestational sac embedded in the cesarean scar.

Treatment depends on clinical factors like pregnancy stage and patient stability. Options include medical treatment (methotrexate), surgical methods, and combined approaches. Combining treatments (e.g., methotrexate with surgery or embolization) appears to improve outcomes and reduce complications compared to single methods.

Conclusion

Cesarean scar pregnancy is an emerging clinical challenge due to rising cesarean section rates worldwide. Early recognition with transvaginal ultrasound is essential. Individualized management based on patient stability, reproductive wishes, and available expertise is necessary. A multidisciplinary approach involving obstetricians, radiologists, and interventional specialists can improve outcomes and reduce morbidity.

References

[1] Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. American Journal of Obstetrics and Gynecology. 2012. [2] Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstetrics and Gynecology. 2006. [3] Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound in Obstetrics and Gynecology. 2003.

Copyright

Copyright © 2026 Dr. Namrata Gabu, Dr. Harsh Pandya, Dr. Akshar Gabu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.