Evaluation of treatment modalities of cesarean scar pregnancy

Open Access

Abstract

Background: Cesarean scar pregnancy (CSP) occurs when a gestational sac implants within the myometrium or fibrous tissue of a previous cesarean section scar. Management of CSP is challenging as there are no specific guidelines and management should be individualized. Aim of the study: This study aimed to evaluate different treatment modalities for diagnosed CSP cases. Methods & Materials: This retrospective observational study was done at the Obstetrics & Gynecology Department, Bangladesh Medical University (BMU), and Central Hospital, Dhaka, Bangladesh from June 2023 June 2025. Patients were grouped by gestational age, <7.5 weeks (n=10) and >7.5 weeks (n=7), managed according to unit protocol, and treatment modality was recorded. Serum β-hCG was measured pre-treatment and on day 7 to assess percentage decline, with ultrasound follow-up at 15 days and clinical follow-up up to 6 weeks.  Results: Among 17 cesarean scar pregnancy cases, 10 were <7.5 weeks and 7 were >7.5 weeks. Mean age, symptoms, number of prior cesarean deliveries, and abortion history were similar between groups, with nearly half asymptomatic and bleeding the commonest symptom, and all comparisons were non-significant (p=0.93). Methotrexate plus folinic acid was used in 47.1% overall, while laparotomy with excision of the gestational sac was the most frequent procedure (35.3%), and other modalities were used in small proportions without significant group differences (p=0.42). Pre-treatment β-hCG was comparable between groups, and it declined by day 7 in both; the mean percentage fall was higher in the <7.5-week group (88.87% vs 82.56%), but remained non-significant (p>0.05). Conclusion: Early diagnosis is very important to reducing complication and also in successful management. Medical management may be considered first for hemodynamically stable patients, whereas invasive procedures should be reserved for active bleeding, suspected rupture, high-risk features, or failed conservative therapy.