EP21.03: Caesarean scar pregnancy: clinical evolution, ultrasound diagnosis and endoscopic correlations

The prognosis of clinical evolution for Caesarean scar pregnancy (CSP) remains commonly uncertain. A series of 9 cases of diagnosis and treatment of CSP with various ultrasound (US) characteristics, morphological, and clinical features are presented. A series of 9 cases of diagnosis and treatment of CSP with various ultrasound characteristics, morphological, and clinical features are presented. Among the cases, 2 progressed to placenta accreta spectrum (PAS), one of which occurred early in the second trimester and resulted in significant surgical complications. Severe bleeding was observed in three patients, while placenta previa without PAS formation was the outcome in another case. In one patient, a uterovesical fistula formed towards the end of the first trimester, leading to fetal migration into the maternal bladder. In three cases, pregnancy progressed up to 6, 9 and 10 GW with deformation of the serous line by the growing gestational sac. Treatment strategies varied, including transcervical elimination in one case, laparoscopic intervention in four, and hysterectomy in two. Ultrasound images, infographics, and endoscopic video files are presented. Early diagnosis of CSP at 6-7 weeks gestation, coupled with counselling regarding the risks of PAS and uterine rupture, is imperative. The consensus outlined by Jordans et al. (2022) provides an optimal framework for delineating US characteristics of early CSP and guiding treatment decisions based on these findings. Notably, sharp curettage poses a heightened risk of severe bleeding. Therefore, access to US and surgical expertise at specialised centres, alongside ongoing training for sonologists and gynecologists, is indispensable. Simultaneous consideration of US and endoscopic images is important for diagnostic experience and the competence of the sonologist.