Case Series on Case-based Approach in Management of Cesarean Scar Ectopic Pregnancy in Different Clinical Scenarios

These days, there is a noticeable rise in the number of pregnancies ending in scar surgery.This could be explained by the rise in the number of cesarean sections performed as well as advancements in diagnostic technologies like transvaginal ultrasonography (TVUS).In obstetrics, diagnosing and treating ectopic cesarean scar pregnancy (CSP) has become difficult.The study's objectives are to assess different diagnostic techniques (namely, ultrasonography) and examine successful CSP treatment strategies based on the patient's hemodynamic profile, factor, and current facility conditions.Considering all of the dangers and issues associated with a CSP, we must assess the patient and manage them accordingly, making the right decisions as soon as possible.In our study, we present four different cases where all patients presented in different ways and hence managed accordingly with good clinical outcome.As the patients came to us were referred from periphery centers in emergency after getting treated inadequately and we had less time for the evaluation in emergency and the diagnosis was blurred due to nonavailability of expertise during emergency hours.But if we rely on our clinical skills and do not delay the treatment, we can save the life of patient.We have managed the patients with exploration followed by obstetric hysterectomy in cases where patient had hemodynamically instability or going toward sepsis but also, we have given trial to conservative methods such as injectable methotrexate (MTX), uterine artery embolization (UAE) and USG-guided hysteroscopic dilatation and curettage, hence preserving the uterus.But sometimes, as in case no 1, we tried medical management along with UAE but eventually failed and had to go for obstetric hysterectomy.