title: Cesarean Scar Pregnancy: A Systematic Review.
abstract: A relatively new type of ectopic pregnancy is cesarean scar pregnancy (CSP). This is related to the increasing number of cesarean deliveries and the advances in imaging. There are 2 types of CSP: CSP with progression to the cervicoisthmic space or uterine cavity (type I, endogenic type) or with deep invasion of scar defect with progression toward the bladder and abdominal cavity (type II, exogenic type). The endogenic type of CSP could result in a viable pregnancy, yet with a high risk of bleeding at the placental site. The exogenic type could be complicated with uterine rupture and bleeding early in pregnancy. Because early diagnosis and treatment are important for the best outcome, every pregnant woman with a history of cesarean delivery should be screened early in the first trimester of pregnancy. Diagnosis can be achieved with ultrasound and Doppler imaging. To date, there have been only 5 randomized studies on CSP, and evidence-based management remains unclear. Until then, treatment should be individualized according to many factors including clinical presentation, beta-human chorionic gonadotropin levels, imaging features, and the surgeon's skill.
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
authors.forename: Natalia
authors.initials: N
authors.lastname: Gonzalez
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada. Electronic address: togas.tulandi@mcgill.ca.
authors.forename: Togas
authors.initials: T
authors.lastname: Tulandi
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D018997:Chorionic Gonadotropin, beta Subunit, Human; D002921:Cicatrix / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D014599:Uterus / Q000473:pathology / Q000601:surgery
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human
keywords: Cesarean scar pregnancy; Ectopic pregnancy and cesarean scar; Scar pregnancy