Cesarean scar ectopic pregnancy: emerging trends in diagnosis, advanced imaging techniques, and management options

PURPOSE OF REVIEW: Cesarean scar ectopic pregnancy (CSEP) is an uncommon but increasingly encountered pathology associated with severe maternal morbidity. Rising cesarean delivery rates and improved early pregnancy imaging have led to greater recognition of CSEP, highlighting the need for standardized diagnostic frameworks and evidence-based management strategies. RECENT FINDINGS: Recent literature emphasizes early first-trimester transvaginal ultrasound for diagnosis and risk stratification. Classification systems incorporating gestational sac location and residual myometrial thickness have been created to predict hemorrhage risk, placenta accreta spectrum, and treatment failure. Evidence increasingly supports classification-driven, interventional management, with surgical approaches demonstrating the highest success rates for higher-risk CSEP types. Non-excisional therapies, including medical and other interventional techniques, may be appropriate in selected early cases. Long-term data suggest that fertility is often preserved following uterus-sparing treatment, although recurrence and abnormal placentation remain important considerations. SUMMARY: CSEP represents a complex clinical entity requiring early recognition and individualized management. Use of standardized sonographic criteria and classification-based treatment strategies improves maternal outcomes while preserving fertility when appropriate. Ongoing efforts to refine risk stratification and better define long-term reproductive outcomes are essential to optimize counseling and care.