Outcome of cesarean scar ectopic pregnancy continued to viability: Data from the International CSEP Registry - PubMed

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Cesarean scar ectopic pregnancy (CSEP) is a rare but serious complication linked to prior cesarean sections, with significant risks including severe maternal morbidity, life-threatening hemorrhage, and hysterectomy.
An international registry study analyzed 115 expectantly managed first-trimester live CSEP cases, finding that 67% reached viability (≥23 weeks) and resulted in live births, while 33% resulted in pregnancy loss between 13 and 22 weeks.
Peripartum hysterectomy was required in 43.5% of cases, with first-trimester ultrasound findings: residual myometrial thickness below 2.5 mm identified 80% of hysterectomy cases (sensitivity 64%, specificity 75%, PPV 76%), and enhanced subplacental vascularity was significantly more frequent in the hysterectomy group (86.2% vs. 59.1%, OR 4.13).
The study concluded that expectant management of CSEP carries substantial risks of second-trimester loss and hysterectomy, emphasizing the importance of early ultrasound evaluation to identify high-risk cases and guide patient counseling and management.

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