Pregnancy on Scar: About 3 Cases

Introduction: Pregnancy on a cesarean scar is a rare form of ectopic pregnancy that occurs within the myometrium of a previous cesarean scar. Its incidence is estimated between 1 in 1,800 and 1 in 2,500 pregnancies. This condition poses significant risks, including massive hemorrhage and uterine rupture, due to its often-delayed diagnosis and challenging management. Methods: Authors present three clinical cases of pregnancies on cesarean scars, managed at our maternity ward. Diagnostic and treatment approaches varied, including methotrexate therapy and surgical interventions. Authors analyzed the incidence, diagnostic criteria, and treatment outcomes based on these cases and recent literature. Results: The incidence of pregnancies on cesarean scars in our service was 0.05%. Diagnoses were made through ultrasound, with advanced imaging used when necessary. Treatments included methotrexate and surgical procedures, with success rates comparable to those reported in the literature. Management strategies were adapted to individual patient circumstances. Discussion: The incidence of pregnancies on cesarean scars appears to be increasing. Diagnostic challenges and the potential for severe complications necessitate early detection and tailored treatment strategies. Methotrexate remains a key component of medical management, though surgical options are essential for severe cases. Preventive measures, including early ultrasound screening and scar assessment, are recommended to reduce recurrence risks. Conclusion: Early diagnosis and appropriate management of pregnancies on cesarean scars are crucial to prevent severe outcomes. The increasing frequency of this condition highlights the need for continued research and development of standardized diagnostic and treatment protocols. Ensuring thorough evaluation and individualized care can significantly improve patient outcomes.