Management of patients with a live cesarean scar pregnancy
Management of patients with a live cesarean scar pregnancy
Patients with CSP and embryonic/fetal demise are managed differently; refer to related UpToDate content regarding management of such patients.
CSP: cesarean scar pregnancy;
PAS: placenta accreta spectrum.
* CSPs are associated with high morbidity (eg, hemorrhage, uterine rupture, PAS) and even maternal mortality.
¶ Patients with CSPs on-the-scar (type 1) rather than in-the-niche (type 2) appear to have more favorable outcomes; however, most studies do not specify CSP type.
Δ Most ultrasound reports do not specify CSP type. ◊ Medical therapies include intragestational injection of methotrexate or potassium chloride, and transcervical insertion of balloon catheters; surgical therapies include operative resection and ultrasound-guided suction aspiration. Adjunctive therapy includes uterine artery embolization and/or systemic methotrexate. These are described in detail separately.
§ In our experience, surgical rather than medical treatment of second-trimester CSP is associated with higher rates of pregnancy resolution.
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