Authors: Lukáš Vaněk ; Jan Zapletal ; Borek Sehnal ; Lukáš Rob ; Michael J. Halaška Authors place of work: Gynekologicko-porodnická klinika 3. LF UK a FN Královské Vinohrady, Praha Published in the journal: Ceska Gynekol 2025; 90(6): 463-468 Category: Kazuistika doi: https://doi.org/10.48095/cccg2025463
Caesarean scar pregnancy is a rare form of ectopic pregnancy. It can be reliably diagnosed through transvaginal ultrasonography, typically during the 1st or early 2nd trimester. While one-third of patients remain asymptomatic, others may develop severe complications. The most common symptoms are vaginal bleeding and abdominal pain, with rare cases involving uterine rupture or the development of placenta accreta spectrum. Caesarean scar pregnancy is associated with a risk of various complications and poses a risk factor for future pregnancies. In many cases, surgical intervention cannot be avoided. Treatment options include surgical management or medical therapy. In some cases, an expectant management approach may be chosen. No single treatment method has yet been definitively established as sufficiently rapid, safe, and effective. This case report presents a patient with twin pregnancy in a caesarean scar, in whom a conservative approach was chosen due to the low gestational age. Additionally, we provide a literature review of the current therapeutic options for managing this challenging condition.
ectopic pregnancy – pregnancy – caesarean scar pregnancy – twin pregnancy
1. Hanáček J, Heřman H, Křepelka P et al. Gravi - dita v jizvě po císařském řezu. Ceska Gynekol 2022; 87 (3): 193–197. doi: 10.48095/cccg2022193.
2. Riaz RM, Williams TR, Craig BM et al. Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes. Abdom Imaging 2015; 40 (7): 2589–2599. doi: 10.1007/s00261-015-0472-2.
3. Ko JK, Li RH, Cheung VY. Caesarean scar pregnancy: a 10-year experience. Aust N Z J Obstet Gynaecol 2015; 55 (1): 64–69. doi: 10.1111/ ajo.12273.
4. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006; 107 (6): 1373–1381. doi: 10.1097/01.AOG.00002 18690.24494.ce.
5. Sehnal B, Hanáček J, Matěcha J et al. Fertilitu šetřící terapie u ektopické gravidity. Ceska Gynekol 2023; 88 (1): 20–26. doi: 10.48 095/cccg202320.
6. Hameed MS, Wright A, Chern BS. Cesarean scar pregnancy: current understanding and treatment including role of minimally invasive surgical techniques. Gynecol Minim Invasive Ther 2023; 12 (2): 64–71. doi: 10.4103/gmit.gmit_116_22.
7. Timor-Tritsch IE, Kaelin Agten A, Monteagudo A et al. The use of pressure balloons in the treatment of first trimester cesarean scar pregnancy. Best Pract Res Clin Obstet Gynaecol 2023; 91 : 102409. doi: 10.1016/j.bpobgyn.2023. 102409.
8. Timor-Tritsch IE, Monteagudo A, Santos R et al. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 2012; 207 (1): 44.e1–44.e13. doi: 10.1016/j.ajog.2012.04.018.
9. Tam LM, Kotani T, Linh TM et al. Outcome of cesarean scar pregnancy treated with local methotrexate injection. Nagoya J Med Sci 2020; 82 (1): 15–23. doi: 10.18999/nagjms.82.1.15.
10. Pickett CM, Minalt N, Higgins OM et al. A laparoscopic approach to cesarean scar ectopic pregnancy. Am J Obstet Gynecol 2022; 226 (3): 417–419. doi: 10.1016/j.ajog.2021.11.021.
11. Karásek V. Gravidita v jizvě po císařském řezu – kazuistika. Ceska Gynekol 2015; 80 (5): 382–385.
12. Totka A, Gábor M, Alföldi M et al. Sonograficky riadená vákuumaspiračná liečba ektopickej gravidity v jazve po cisárskom reze. Ceska Gynekol 2021; 86 (3): 184–188. doi: 10.48095/cccg 2021184.
13. Zahálková L, Kacerovský M. Ektopická gravidita v jizvě po císařském řezu. Ceska Gynekol 2016; 81 (6): 414–419.
14. Hanáček J, Heřman H, Brandejsová A et al. Gravidita v jizvě po císařském řezu – retrospektivní analýza případů z let 2012–2021. Ceska Gynekol 2022; 87 (4): 245–248. doi: 10.48095/cccg2022245.
15. Hlinecká K, Lisá Z, Richtárová A et al. Intramyometrální gravidita po hysteroskopické resekci reziduí – kazuistika. Ceska Gynekol 2022; 87 (1): 35–39. doi: 10.48095/cccg202235.
16. Elson CJ, Salim R, Potdar N et al. Diagnosis and management of ectopic pregnancy. On behalf of the Royal College of Obstetricians and Gynaecologists. BJOG 2016; 123: e15–e55.
17. Fiala C, Gemzel-Danielsson K. Review of medical abortion using mifepristone in combination with a prostaglandin analogue. Contraception 2006; 74 (1): 66–86. doi: 10.1016/j.contraception.2006.03.018.
18. Jauniaux E, Jurkovic D, Hussein AM et al. New insights into the etiopathology of placenta accreta spectrum. Am J Obstet Gynecol 2022; 227 (3): 384–391. doi: 10.1016/j.ajog.2022.02.038.
19. Myatt L, Lye SJ. Expression, localization and function of prostaglandin receptors in myometrium. Prostaglandins Leukot Essent Fatty Acids 2004; 70 (2): 137–148. doi: 10.1016/j.plefa. 2003.04.004.
20. Cecchini F, Tassi A, Londero AP et al. First trimester uterine rupture: a case report and literature review. Int J Environ Res Public Health 2020; 17 (8): 2976. doi: 10.3390/ijerph17082976.
21. Chen BA, Reeves MF, Creinin MD et al. Misoprostol for treatment of early pregnancy failure in women with previous uterine surgery. Am J Obstet Gynecol 2008; 198 (6): 626.e1–626.e5. doi: 10.1016/j.ajog.2007.11.045.
22. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol 2009; 113 (5): 1117–1123. doi: 10.1097/AOG.0b013e31819dbfe2.
23. Racková J, Driák D, Neumannová H et al. Použití metotrexátu u ektopické gravidity a tehotenství neznámé lokalizace. Ceska Gynekol 2016; 81 (2): 141–146.
24. Švédová B, Hruda M, Drochýtek V et al. Postupy u různých typů ektopické gravidity – dotazníková studie. Ceska Gynekol 2025; 90 (2): 141–148. doi: 10.48095/cccg2025141.
25. Kaelin Agten A, Cali G, Monteagudo A et al. The clinical outcome of cesarean scar pregnancies implanted “on the scar” versus “in the niche”. Am J Obstet Gynecol 2017; 216 (5): 510.e1–510.e6. doi: 10.1016/j.ajog.2017.01.019.
26. Timor-Tritsch IE, Monteagudo A, Bennett TA et al. A new minimally invasive treatment for cesarean scar pregnancy and cervical pregnancy. Am J Obstet Gynecol 2016; 215 (3): 351.e1–351.e8. doi: 10.1016/j.ajog.2016.03.010.
27. Driák D, Sehnal B, Jarošová L et al. Perforace dělohy při nitroděložních výkonech a její řešení. Ceska Gynekol 2022; 87 (4): 295–301. doi: 10.48095/cccg2022295.
28. Cerovac A, Habek D. Viable invasive cervical pregnancy treated with minimally invasive procedures. Ceska Gynekol 2023; 88 (5): 380–382. doi: 10.48095/cccg2023380.
29. Di Spiezio Sardo A, Zizolfi B, Saccone G et al. Hysteroscopic resection vs ultrasound-guided dilation and evacuation for treatment of cesarean scar ectopic pregnancy: a randomized clinical trial. Am J Obstet Gynecol 2023; 229 (4): 437.e1–437.e7. doi: 10.1016/j.ajog.2023. 04.038.
ORCID autorů
L. Vaněk 0009-0006-1908-2052
J. Zapletal 0000-0003-2705-2970
B. Sehnal 0000-0003-2622-2181
L. Rob 0000-0003-3770-651X
M. J. Halaška 0000-0001-6404-4537
Doručeno/Submitted: 7. 7. 2025
Přijato/Accepted: 10. 7. 2025
MUDr. Lukáš Vaněk
Gynekologicko-porodnická klinika
3. LF UK a FNKV
Šrobárova 1150/50
100 34 Praha 10
lukas.vanek@fnkv.cz
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