Natural evolution of a cesarean scar pregnancy up to 34 weeks complicated by an early subserosal uterine rupture and placenta accreta spectrum disorders

Cesarean scar pregnancy (CSP) is an extremely rare form of ectopic pregnancy. A 39-year-old woman with a history of multiple uterine surgeries was diagnosed with a CSP at seven weeks by transvaginal ultrasound. The CSP was misdiagnosed at 13 weeks and 5 days during a second medical opinion. At 22 weeks of gestation, a 3.8 cm subserosal uterine rupture was visualized. Expectant management was decided. A live birth was achieved through an elective cesarean section at 34 weeks of gestation. The complications were early subserosal uterine rupture and placenta accreta spectrum that led to a hysterectomy. Due to risk of uterine rupture, management should consist of early termination of the pregnancy.