Implantation of a pregnancy within the scar or uterine defect from a prior cesarean delivery is called a Cesarean Scar Pregnancy (CSP). CSP is a complication of early pregnancy and carries significant risks of severe maternal morbidity. It should not be expectantly managed. However, optimal treatment between surgical, medical, or minimally invasive therapies are currently unknown. Patients who choose expectant management, although not recommended, should be delivered between 34w7d and 35w6d by repeat cesarean with strong counseling regarding subsequent risks for repeat CSP
Optimal management for treatment of CSP is unknown
…operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided vacuum aspiration be considered for surgical management of CSP and that sharp curettage alone be avoided
…intragestational methotrexate for medical treatment of CSP, with or without other treatment modalities
We recommend that systemic methotrexate alone not be used to treat CSP
Note: Due to possibility of late preterm delivery and hemorrhage risk, administer betamethasone administration for fetal lung maturity and include a multi-disciplinary team with Level III/IV facility
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