{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:04:49Z","timestamp":1790690689691,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T00:00:00Z","timestamp":1600905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy, defined as the implantation of the gestational sac at the uterine incision scar of the previous cesarean section. This condition is associated with severe maternal and fetal\/neonatal complications, including severe bleeding, rupture of the uterus, fetal demise, or preterm delivery. In view of these, early diagnosis allows the option of termination of pregnancy. In this case report, we present a patient with a cesarean scar pregnancy who was diagnosed at the sixth week of gestation but declined early termination of the pregnancy and was managed to the 38th week. Placenta previa was confirmed in the second trimester. A planned cesarean section was performed that resulted in the birth of a live full-term neonate. Intraoperatively, placenta percreta was diagnosed, and due to uncontrollable bleeding, a hysterectomy was performed. The postoperative course was uneventful. In cases where an early diagnosis of CSP is made, women should be counseled that this will almost certainly evolve to placenta previa, and the associated risks should be explained. Close follow-up of CSP is mandatory if expectant management is selected. Further studies are needed for definitive conclusions and to determine the risks of expectant management.<\/jats:p>","DOI":"10.3390\/medicina56100496","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T08:33:03Z","timestamp":1600936383000},"page":"496","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Cesarean Scar Pregnancy Successfully Managed to Term: When the Patient Is Determined to Keep the Pregnancy"],"prefix":"10.3390","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3788-9013","authenticated-orcid":false,"given":"Ranko","family":"Kutlesic","sequence":"first","affiliation":[{"name":"Clinic of Gynaecology and Obstetrics, University Clinical Centre Nis, 18000 Nis, Serbia"},{"name":"Faculty of Medicine, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marija","family":"Kutlesic","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Clinic of Gynaecology and Obstetrics, University Clinical Centre Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Predrag","family":"Vukomanovic","sequence":"additional","affiliation":[{"name":"Clinic of Gynaecology and Obstetrics, University Clinical Centre Nis, 18000 Nis, Serbia"},{"name":"Faculty of Medicine, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milan","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Clinic of Gynaecology and Obstetrics, University Clinical Centre Nis, 18000 Nis, Serbia"},{"name":"Faculty of Medicine, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danka","family":"Mostic-Stanisic","sequence":"additional","affiliation":[{"name":"Institute of Gynaecology and Obstetrics Belgrade, Clinical centre of Serbia, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/uog.14775","article-title":"Natural history of early first-trimester pregnancies implanted in Cesarean scars","volume":"46","author":"Zosmer","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ajog.2017.05.067","article-title":"Placenta accreta spectrum: Pathophysiology and evidence-based anatomy for prenatal ultrasound imaging","volume":"218","author":"Jauniaux","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1097\/01.AOG.0000219750.79480.84","article-title":"National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries","volume":"107","author":"Silver","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1002\/uog.56","article-title":"First trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar","volume":"21","author":"Jurkovic","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"632.e1","DOI":"10.1016\/j.ajog.2009.02.001","article-title":"Changing trends in peripartum hysterectomy over the last 4 decades","volume":"200","author":"Flood","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"601","DOI":"10.7863\/ultra.34.4.601","article-title":"Cesarean scar pregnancies: Experience of 60 cases","volume":"34","author":"Khatib","year":"2015","journal-title":"J. Ultrasound Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1002\/uog.20244","article-title":"Impact of placenta previa with placenta accreta spectrum disorder on fetal growth","volume":"54","author":"Jauniaux","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1471-0528.2006.01237.x","article-title":"Cesarean scar pregnancy","volume":"114","author":"Ash","year":"2007","journal-title":"BJOG"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1002\/bdr2.1135","article-title":"Hypoxia and placental Development","volume":"109","author":"Soares","year":"2017","journal-title":"Birth Defects Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.placenta.2020.05.011","article-title":"Ultrasound-histopathologic features of the utero-placental interface in placenta accreta spectrum","volume":"97","author":"Jauniaux","year":"2020","journal-title":"Placenta"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"379.e1","DOI":"10.1016\/j.ajog.2019.11.1246","article-title":"A new methodologic approach for clinico-pathologic correlations in invasive placenta previa accrete","volume":"222","author":"Jauniaux","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1002\/uog.17440","article-title":"First-trimester prediction of surgical outcome in abnormally invasive placenta using the cross-over sign","volume":"51","author":"Forlani","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/uog.16216","article-title":"Natural history of Cesarean scar pregnancy on prenatal ultrasound: The crossover sign","volume":"50","author":"Cali","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1002\/uog.21939","article-title":"Value of first-trimester ultrasound in prediction of third-trimester sonographic stage of placenta accreta spectrum disorder and surgical outcome","volume":"55","author":"Forlani","year":"2020","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e0202020","DOI":"10.1371\/journal.pone.0202020","article-title":"New ultrasound grading system for cesarean scar pregnancy and its implications for management strategies: An observational cohort study","volume":"13","author":"Lin","year":"2018","journal-title":"PLoS ONE"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/uog.20104","article-title":"Screening for morbidly adherent placenta in early pregnancy","volume":"53","author":"Panaiotova","year":"2019","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.ajog.2016.07.044","article-title":"Accreta placentation: A systematic review of prenatal ultrasound imaging and grading of villous invasiveness","volume":"215","author":"Jauniaux","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/uog.13327","article-title":"Prenatal identification of invasive placentation using magnetic resonance imaging: Systematic review and meta-analysis","volume":"44","author":"Iacovella","year":"2014","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1016\/j.ultrasmedbio.2013.05.017","article-title":"Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: A systematic review and meta-analysis","volume":"39","author":"Meng","year":"2013","journal-title":"Ultrasound Med. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1111\/1471-0528.12918","article-title":"The morbidly adherent placenta: Early accurate diagnosis is essential for the meaningful interpretation of outcomes","volume":"121","author":"Zosmer","year":"2014","journal-title":"BJOG"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/ijgo.12900","article-title":"Development of a training program for the ultrasound screening of placenta accreta spectrum disorders","volume":"147","author":"Dimitrova","year":"2019","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"44.e1","DOI":"10.1016\/j.ajog.2012.04.018","article-title":"The diagnosis, treatment, and follow-up of cesarean scar pregnancy","volume":"207","author":"Monteagudo","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.ajog.2012.03.007","article-title":"Unforeseen consequences of the increasing rate of cesarean deliveries: Early placenta accreta and cesarean scar pregnancy. A review","volume":"207","author":"Monteagudo","year":"2012","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.jmig.2017.05.019","article-title":"Cesarean scar pregnancies: A systematic review of treatment options","volume":"24","author":"Li","year":"2017","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lu, F., Liu, Y., and Tang, W. (2019). Successful treatment of cesarean scar pregnancy with transvaginal injection of absolute ethanol around the gestation sac via ultrasound. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2468-3"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.ejogrb.2011.01.016","article-title":"Methotrexate therapy followed by suction curettage followed by Foley tamponade for cesarean scar pregnancy","volume":"156","author":"Jiang","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1016\/j.fertnstert.2015.12.130","article-title":"Cesarean scar pregnancy: A systematic review of treatment studies","volume":"105","author":"Petersen","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"B2","DOI":"10.1016\/j.ajog.2020.01.030","article-title":"Society for Maternal-Fetal Medicine (SMFM) Consult Series #49: Cesarean scar pregnancy","volume":"222","author":"Miller","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/uog.17568","article-title":"Outcome of Cesarean scar pregnancy managed expectantly: Systematic review and meta-analysis","volume":"51","author":"Monteaugudo","year":"2018","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Morlando, M., Buca, D., Timor-Tritsch, I.E., Cali, G., Palacios-Jaraquemada, J., Monteagudo, A., Khalil, A., Cennamo, C., La Manna, V., and Liberati, M. (2020). Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis. Acta Obstet. Gynecol. Scand.","DOI":"10.1111\/aogs.13918"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/10\/496\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:13:08Z","timestamp":1760177588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/56\/10\/496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,24]]},"references-count":30,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["medicina56100496"],"URL":"https:\/\/doi.org\/10.3390\/medicina56100496","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,24]]}}}