{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T13:49:02Z","timestamp":1789566542451,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002674","name":"Russian Academy of Sciences","doi-asserted-by":"crossref","award":["125021302125-6 FGFZ-2025-0005"],"award-info":[{"award-number":["125021302125-6 FGFZ-2025-0005"]}],"id":[{"id":"10.13039\/501100002674","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Post-cesarean section scar niche pregnancy is one of the rarest forms. It is characterized by implantation of the gestation sac within the scar niche and is often associated with chorionic villi adhesion into the thinned cesarean section scar. The increasing incidence of this condition is associated with the increasing frequency of cesarean sections and the widespread use of ultrasound in early pregnancy. The most significant clinical findings are the detection of chorionic villus invasion and uterine wall insufficiency, which may be detected using magnetic resonance imaging, including contrast, and are crucial for determining patient management. This pathology may be considered life-threatening due to complications such as early uterine rupture with bleeding, which, if not diagnosed promptly, can lead to hysterectomy and loss of the woman\u2019s reproductive health. Early diagnosis allows for the use of conservative treatment methods, preserving the uterus. The aim of the study is to clarify the clinical practices to follow in cases where an MRI examination with contrast agent is indicated to be performed on a pregnant patient. Methods: Ultrasound and MRI examination with counter-rotation, as well as histological and immunohistochemical examination of the remnants of the gestational sac were performed. Results: A 36-year-old pregnant woman was hospitalized in her eighth week of pregnancy with complaints of vaginal bleeding and persistent abdominal pain. An ultrasound scan revealed a pregnancy of 8 weeks and 5 days, and a low-lying chorion in the isthmus of the uterus, along with thinning of the cesarean scar and the formation of a scar niche resembling a hernia. Early signs of chorionic invasion were not treated. An MRI revealed signs of superficial chorionic adhesion to the cesarean scar, both to the isthmus and the internal os. Given that the woman did not wish to continue the pregnancy, uterine artery embolization was performed to reduce potential blood loss. Subsequently, laparoscopy, adhesiolysis, vacuum aspiration of the gestational sac, uterine curettage, hysteroresectoscopy, and coagulation of the fetal bed were performed. Histological and immunohistochemical examination revealed signs of inflammation in the area of the suspected lesion. Conclusions: This case report shows the potential value of MRI in complex cases of ultrasound detection of a gestational sac within scar tissue. MRI was used to assess the location of the gestational sac and evaluate the thickness of the cesarean scar to detect its dysfunction. Furthermore, contrast enhancement of the MRI may be useful in the most complex cases but requires an informed consent discussion with the patient. However, the latter issue requires discussion and proof of its safety for the fetus.<\/jats:p>","DOI":"10.3390\/jcm15062302","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T16:20:14Z","timestamp":1773764414000},"page":"2302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnosis and Treatment of Ectopic Pregnancy in a Cesarean Section Scar\u2014Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0363-3669","authenticated-orcid":false,"given":"Polina V.","family":"Kulabukhova","sequence":"first","affiliation":[{"name":"Federal State Budgetary Institution \u201cNational Medical Research Center of Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov\u201d Ministry of Health of the Russian Federation, 117997 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2467-7660","authenticated-orcid":false,"given":"Tatyana V.","family":"Fokina","sequence":"additional","affiliation":[{"name":"Avtsyn Research Institute of Human Morphology of Federal State Budget Scientific Institution, Petrovsky National Research Center of Surgery, 119435 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0273-9669","authenticated-orcid":false,"given":"Maria N.","family":"Babaeva","sequence":"additional","affiliation":[{"name":"Avtsyn Research Institute of Human Morphology of Federal State Budget Scientific Institution, Petrovsky National Research Center of Surgery, 119435 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8739-5209","authenticated-orcid":false,"given":"Aleksandra V.","family":"Asaturova","sequence":"additional","affiliation":[{"name":"Federal State Budgetary Institution \u201cNational Medical Research Center of Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov\u201d Ministry of Health of the Russian Federation, 117997 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5592-5690","authenticated-orcid":false,"given":"Natalia V.","family":"Nizyaeva","sequence":"additional","affiliation":[{"name":"Avtsyn Research Institute of Human Morphology of Federal State Budget Scientific Institution, Petrovsky National Research Center of Surgery, 119435 Moscow, Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e031193","DOI":"10.1136\/bmjopen-2019-031193","article-title":"Epidemiology of placenta previa accreta: A systematic review and meta-analysis","volume":"9","author":"Jauniaux","year":"2019","journal-title":"BMJ Open"},{"key":"ref_2","first-page":"573","article-title":"Cesarean Scar Pregnancy: Diagnosis and Pathogenesis","volume":"46","author":"Monteagudo","year":"2019","journal-title":"Obstet. 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