Clinical Profile and Management Outcomes of Cesarean Scar Ectopic Pregnancy: A Cross-Sectional Study from a Tertiary Care Center

Abstract

Introduction: Scar ectopic pregnancy (SEP) is a life-threatening condition where an embryo implants within the myometrium of a previous uterine scar. With an incidence of approximately 1 in 2,000 pregnancies, it is an increasingly common cause of maternal morbidity.  Materials and Methods: This cross-sectional study at MGM Medical College (Nov 2023–Jan 2025) analyzed 12 patients with confirmed SEP. Clinical profiles, b-HCG levels, and ultrasound findings were recorded to determine management strategies.  Results: The mean patient age was 30.25 years, with all subjects having a history of at least one Caesarean section (LSCS). The most common symptom was vaginal bleeding (41%), though 33% of patients were asymptomatic. Mean gestational age was 8.3 weeks, and mean b-HCG was 40,960 mIU/mL. Ultrasound classified the majority of cases as Type II (66.7%). Management included diagnostic laparoscopy with suction evacuation (38.4%), laparoscopic excision (23%), and one case (7.6%) requiring a hysterectomy due to scar rupture.  Conclusion: Early diagnosis via transvaginal ultrasound is critical. A history of multiple LSCS correlates with higher risk, necessitating specialized, individualized management to prevent catastrophic outcomes like uterine rupture.              

Keywords: Cesarean scar pregnancy, Ectopic pregnancy, β-hCG, Laparoscopy, Methotrexate