title: Outcome of cesarean scar pregnancies diagnosed sonographically in the first trimester.
abstract: OBJECTIVE
  The purpose of this study was to determine the outcome of cesarean scar pregnancies diagnosed during the first trimester.
  
  
  METHODS
  We retrospectively identified all cesarean scar implantation pregnancies diagnosed by sonography before 14 weeks' gestation between 2000 and 2012 at our institution. We reviewed the patients' sonograms and medical records and recorded sonographic findings and pregnancy outcomes.
  
  
  RESULTS
  Thirty-four cases met study entry criteria. Ten patients presented with no embryonic cardiac activity, of whom 7 underwent interventions, and 3 were expectantly managed. One of the former 7 and none of the latter 3 required hysterectomy for bleeding. Among the 24 patients with embryonic cardiac activity, 8 were managed expectantly: 5 (62.5%) ultimately delivered a live-born neonate, 3 (60.0%) of whom required hysterectomy due to placenta accreta; and 3 had fetal demise. Sixteen of the 24 underwent interventions, 2 opting for gravid hysterectomy (10 and 11 weeks' gestation, respectively) and 14 treated by a minimally invasive method: intrasac potassium chloride injection (3 cases); intrasac potassium chloride injection plus intramuscular methotrexate (4 cases); sonographically guided dilation and curettage (6 cases); and laparascopic resection (1 case). None of the latter 14 subsequently required hysterectomy.
  
  
  CONCLUSIONS
  If a woman has a first-trimester diagnosis of a cesarean scar implantation pregnancy and embryonic cardiac activity is present, expectant management offers the possibility of delivering a live-born neonate (62.5% in our study) but carries a substantial likelihood of hysterectomy at delivery due to placenta accreta (37.5% in our study), whereas minimally invasive therapy that interrupts the pregnancy largely eliminates the need for hysterectomy.
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA. aymichaels@partners.org.
authors: Aya Y
authors: AY
authors: Michaels
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
authors: Erin E
authors: EE
authors: Washburn
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
authors: Katherine D
authors: KD
authors: Pocius
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
authors: Carol B
authors: CB
authors: Benson
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
authors: Peter M
authors: PM
authors: Doubilet
authors: Departments of Radiology (A.Y.M., C.B.B., D.A.C.) and Obstetrics and Gynecology (E.E.W., K.D.P., P.M.D.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts USA.
authors: Daniela A
authors: DA
authors: Carusi
mesh_terms: D002585:Cesarean Section; D002921:Cicatrix / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal
keywords: accreta; cesarean scar pregnancy; minimally invasive therapy; obstetric ultrasound