Management of patients with a live cesarean scar pregnancy

CSP: cesarean scar pregnancy; PAS: placenta accreta spectrum.
* CSPs are associated with high morbidity (eg, hemorrhage, uterine rupture, PAS) and even maternal mortality.
¶ Patients with CSPs on-the-scar (type 1) rather than in-the-niche (type 2) appear to have more favorable outcomes; however, most studies do not specify CSP type.
Δ Most ultrasound reports do not specify CSP type.
◊ Medical therapies include intragestational injection of methotrexate or potassium chloride, and transcervical insertion of balloon catheters; surgical therapies include operative resection and ultrasound-guided suction aspiration. Adjunctive therapy includes uterine artery embolization and/or systemic methotrexate. These are described in detail separately.
§ In our experience, surgical rather than medical treatment of second-trimester CSP is associated with higher rates of pregnancy resolution.