Cesarean scar pregnancy (CSP) is a very rare form of ectopic pregnancy. It complicates approximately 1 in 2226 pregnancies. However, it is becoming increasingly more frequent with the increasing number of cesarean sections performed each year. The recommended approach to treatment is therapeutic termination of pregnancy at the time of recognition. Couples occasionally make the choice to continue with expectant management. There are as few as ten documented cases of CSP and were expectantly managed that resulted in the delivery of a viable neonate. In this article, we present a case of CSP managed expectantly ending in emergency cesarean delivery at 27 weeks gestation. Delivery was complicated by severe postpartum hemorrhage with the need for cesarean hysterectomy. This report suggests the ability to expectantly manage appropriate cesarean scar ectopic pregnancies. However, it also raises several ethical questions whether or not we should manage these patients expectantly merely because we can.
Charles P. Mirable2