Abstract
A caesarean scar pregnancy (CSP) is a pregnancy that implants into the myometrium at the site of a previous uterine incision. In this paper, we present three cases of women affected by caesarean scar implantations. Each case presented differently and was managed in separate ways. We describe their differing presentations and care as well as reflecting on how such women may be better cared for. Endogenic CSPs grow into the uterine cavity and can easily be mistaken for a normal pregnancy implantation. Differentiation can often only be seen at early gestations. All women with a previous uterine scar should potentially be offered early trans-vaginal ultrasound to correctly diagnose the implantation site. However, in many women, the diagnosis is not suspected until a complication arises. We advocate for there to be a higher index of suspicion for CSPs during early pregnancy ultrasound and that all practitioners performing such scans should be trained to allow a confident diagnosis of CSP.
Highlights
Caesarean scar pregnancy is defined as implantation into the myometrium defect occurring at the site of the previous uterine incision
caesarean scar pregnancy (CSP) form a clinical spectrum from a partial implantation over a thick scar, which grows into the uterine cavity, to a pregnancy fully located outside the uterine cavity, only connected to the uterine cavity via a thin tract
The key to the diagnosis is a high index of suspicion and a transvaginal ultrasound (TVS) performed by an appropriately experienced and skilled operator
Summary
Clinical Dilemmas and Risks of Misdiagnosis and Mismanagement Associated with Endogenous Caesarean Scar Pregnancy: A Case Series and Literature Review. A caesarean scar pregnancy (CSP) is a pregnancy that implants into the myometrium at the site of a previous uterine incision. We present three cases of women affected by caesarean scar implantations. Each case presented differently and was managed in separate ways. We describe their differing presentations and care as well as reflecting on how such women may be better cared for. Endogenic CSPs grow into the uterine cavity and can be mistaken for a normal pregnancy implantation. All women with a previous uterine scar should potentially be offered early trans-vaginal ultrasound to correctly diagnose the implantation site. We advocate for there to be a higher index of suspicion for CSPs during early pregnancy ultrasound and that all practitioners performing such scans should be trained to allow a confident diagnosis of CSP.
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