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Pregnancy as a ticking bomb: A sonographic review of type II cesarean section scar pregnancy

Marie Therese Zayco-Magno, MD, FPOGS and Regina Rosario Panlilio, MD, FPOGS, FPSUOG
Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines-Manila

Cesarean section scar pregnancy (CSP) is a pregnancy implanted outside the uterine cavity in the site of a previous cesarean section scar and is considered the rarest form ectopic pregnancy. CSP is a modern phenomenon and has been reported with increasing incidence due to either an increased reporting or increasing cesarean section rate. The true incidence, however, has not been fully determined as some cases will end up in the first trimester and go unreported or undiagnosed. Undiagnosed cesarean scar pregnancy can be fatal due to life threatening hemorrhage as well as uterine rupture due to an abnormally adherent placenta. Accurate diagnosis is important because it enables the clinicians to establish the risk of complications and aid in prompt management. Ultrasonography is often the first step in detecting CSP and MRI should only be used in equivocal cases. The case presented is in a multiparous woman with ultrasound finding of a cesarean scar pregnancy where expectant management was the initial option but because of the outward progression of the CSP, it was terminated. There is no established universal treatment guidelines for CSP and treatment options include expectant, medical, surgical or combinations of these.