Scarred for life: a review of cesarean section scar pregnancy and potential pitfalls in diagnosis

Clinical and historical features of cesarean scar pregnancies in a tertiary hospital with a high rate of cesarean section: A case–control survey

“…During an emergent CS, which is usually due to the failure to labor progress or fetal distress, dilation on the lower segment happens and the incision will be on the lower parts of uterine with thin myometrium layer, while, in an elective CS, lower segment is not dilated and the incision will be on a thick myometrium, therefore, healing with fibrosis will weaken the myometrium, leading to a defect formation, known as "Niche" which carries high risks of CSP on the affected implantation site. [11][12][13] After reviewing of the literature, we assumed that infections could lead to the development of postcesarean scar defects or even changes in the structures of healthy endometrial tissues leading to not only difficulties in implantation, but also developing possible adhesion sites in the anatomy of affected sites in individual with STDs. This negative cycle of events could reinforce the CSP occurrence by delaying tissue repair of the CS scar, however, despite the statistically significant difference between the two study groups, we found no significant relationships between the frequencies of STDs and the occurrence of CSP (p = 0.921).…”

“…Therefore, a cesarean scar defects forms in the anterior wall of the lower uterine segment and it takes time to complete healing. So, when the time interval is too short, the fertilized egg can easily implant here and leads to CSP [13][14][15] ! These results might indicate this possible theory that by encouraging plans, aiming at decreasing the average age of women at the time of their pregnancies along with increasing the overall knowledge of women about the benefits of normal vaginal deliveries instead of CS, we might lead the way to significant declines in the incidence of CSPs.…”

“…During an emergent CS, which is usually due to the failure to labor progress or fetal distress, dilation on the lower segment happens and the incision will be on the lower parts of uterine with thin myometrium layer, while, in an elective CS, lower segment is not dilated and the incision will be on a thick myometrium, therefore, healing with fibrosis will weaken the myometrium, leading to a defect formation, known as “Niche” which carries high risks of CSP on the affected implantation site. 11 , 12 , 13 …”

“…Therefore, a cesarean scar defects forms in the anterior wall of the lower uterine segment and it takes time to complete healing. So, when the time interval is too short, the fertilized egg can easily implant here and leads to CSP 13 , 14 , 15 !…”

MRI Assessment of Cesarean Scar Pregnancies: A Case Series

“…Determination of the exact location of the gestational sac (GS) and invasion of the placenta is necessary to estimate the patient's bleeding risk and to propose to the patient whether to terminate or continue the pregnancy [9]. MRI has been proposed and has useful second-level imaging when ultrasound findings are equivocal and aid in confirming the diagnosis, assessing the bleeding risk, and determining the fat planes and bladder invasion before treatment [5,[10][11][12][13]. Surgical, medical, and minimally invasive therapies have been described for cesarean scar pregnancy management, but therapeutical options vary between institutions and countries [14].…”