{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T14:35:16Z","timestamp":1781534116867,"version":"3.54.5"},"reference-count":18,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T00:00:00Z","timestamp":1617840000000},"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>Background: Cesarean scar ectopic pregnancies are a rare form of extrauterine pregnancies, yet their incidence has increased along with the rise in the number of cesarean deliveries. As with other ectopic pregnancies, cesarean scar ectopic pregnancies pose a greater risk for maternal hemorrhage and ultimately maternal mortality. Case presentation: We present a series of clinical cases of cesarean scar ectopic pregnancy diagnosed by transvaginal ultrasonography. Each patient received an individualized treatment: the rate of success depended on the particular maternal condition in each case. Due to the low frequency of this entity, there are no clear protocols for its treatment and thus there are numerous options for treatment and follow-up: expectant management, medical therapy, surgical intervention, uterine artery embolization or a combined approach. Each method has different levels of success and is dependent on the surgeon\u2019s skill and patient presentation. A transvaginal ultrasound is necessary to obtain the fine details of the gestation sac and its relation to the scar and must be followed by a meticulous abdominal scan with a full bladder. Conclusion: Herein, we present a rare pathological phenomenon whose frequency is on the rise, and for which transvaginal ultrasound and flow Doppler provide high diagnostic accuracy. Early diagnosis of cesarean scar ectopic pregnancies offers treatment options that may help avoid uterine rupture and bleeding, thus preserving the uterus and future fertility.<\/jats:p>","DOI":"10.3390\/medicina57040362","type":"journal-article","created":{"date-parts":[[2021,4,8]],"date-time":"2021-04-08T21:27:44Z","timestamp":1617917264000},"page":"362","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Cesarean Scar Ectopic Pregnancy\u2014Case Series: Treatment Decision Algorithm and Success with Medical Treatment"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6577-0557","authenticated-orcid":false,"given":"Lorena Sabonet","family":"Morente","sequence":"first","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana I. Guzm\u00e1n","family":"Le\u00f3n","sequence":"additional","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5248-9560","authenticated-orcid":false,"given":"M. Pilar Espejo","family":"Reina","sequence":"additional","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8722-0449","authenticated-orcid":false,"given":"Jose R. Anderica","family":"Herrero","sequence":"additional","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7106-092X","authenticated-orcid":false,"given":"Ernesto Gonz\u00e1lez","family":"Mesa","sequence":"additional","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7286-8656","authenticated-orcid":false,"given":"Jes\u00fas S. Jim\u00e9nez","family":"L\u00f3pez","sequence":"additional","affiliation":[{"name":"FEA Obstetric and Gynecology Hospital Regional Materno Infantil, C.P.29011 M\u00e1laga, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"(2018). ACOG Committee on Practice Bulletins Tubal ectopic pregnancy: ACOG practice bulletin. Clin. Manag. Guidel. Obs. Gynecol., 131, e91\u2013e103.","DOI":"10.1097\/AOG.0000000000002560"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.ajog.2011.10.857","article-title":"Ectopic pregnancy not within the (distal) fallopian tube: Etiology, diagnosis, and treatment","volume":"206","author":"Fylstra","year":"2012","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.clp.2008.07.003","article-title":"Placenta accreta and cesarean scar pregnancy: Overlooked costs of the rising cesarean section rate","volume":"35","author":"Rosen","year":"2008","journal-title":"Clin. Perin."},{"key":"ref_4","first-page":"37","article-title":"Cesarean scar pregnancy: A case report","volume":"26","author":"Ekici","year":"2018","journal-title":"Turk. Klin. Jinekoloji Obstet."},{"key":"ref_5","first-page":"372","article-title":"Scar ectopic pregnancy","volume":"65","author":"Patel","year":"2015","journal-title":"J. Med. Biol. Eng."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1097\/01.AOG.0000218690.24494.ce","article-title":"Cesarean scar ectopic pregnancies etiology","volume":"107","author":"Rotas","year":"2006","journal-title":"Am. Coll. Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.12891\/ceog4466.2019","article-title":"Cesarean scar ectopic pregnancy, a life threatening condition: A case report","volume":"46","author":"Zalduegui","year":"2019","journal-title":"Clin. Exp. Obstet. Gyn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1471-0528.2006.01237.x","article-title":"Caesarean scar pregnancy","volume":"114","author":"Ash","year":"2007","journal-title":"BJOG"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1046\/j.1469-0705.2000.00300-2.x","article-title":"Pregnancy in a cesarean scar","volume":"16","author":"Vial","year":"2000","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.5811\/cpcem.2019.10.43988","article-title":"Cesarean Scar Ectopic Pregnancy: Diagnosis With Ultrasound","volume":"4","author":"Hoffman","year":"2020","journal-title":"Clin. Pract. Cases Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Timor-Tritsch, I.E., Monteagudo, A., Cali, G., El Refaey, H., Kaelin Agten, A., and Arslan, A.A. (2016). Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester. Am. J. Obstet. Gynecol.","DOI":"10.1016\/j.ajog.2016.02.028"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2589","DOI":"10.1007\/s00261-015-0472-2","article-title":"Cesarean scar ectopic pregnancy: Imaging features, current treatment options, and clinical outcomes","volume":"40","author":"Riaz","year":"2015","journal-title":"Abdom. Imaging"},{"key":"ref_13","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 Caesarean section scar","volume":"21","author":"Jurkovic","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1111\/j.1471-0528.2005.00532.x","article-title":"Caesarean scar pregnancy successfully treated by operative hysteroscopy and suction curettage","volume":"112","author":"Wang","year":"2005","journal-title":"BJOG"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Zhuang, Y., and Huang, L. (2009). Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar. Am. J. Obstet. Gynecol.","DOI":"10.1016\/j.ajog.2009.04.038"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1002\/uog.12","article-title":"Management of a case of uterine scar pregnancy by transabdominal potassium chloride injection","volume":"21","author":"Hartung","year":"2003","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.bpobgyn.2017.09.003","article-title":"Uterine artery embolization: A review of current concepts","volume":"46","author":"Keung","year":"2018","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Deans, R., and Abbott, J. (2009). Hysteroscopic management of cesarean scar ectopic pregnancy. Fertil. Steril.","DOI":"10.1016\/j.fertnstert.2008.12.099"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/362\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T14:12:05Z","timestamp":1760364725000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/362"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,8]]},"references-count":18,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["medicina57040362"],"URL":"https:\/\/doi.org\/10.3390\/medicina57040362","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202103.0496.v1","asserted-by":"object"}]},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,8]]}}}