Caesarean Scar Pregnancy

Incidence of cesarean scar pregnancy: On average 1 in 2000 pregnancies, but the incidence is increasing.

Is every case of placenta percreta a scar pregnancy?

Yes, it is a scar pregnancy (provided that the placenta implants at the site of the caesarean section).

Caesarean scar pregnancy is diagnosed by : It is diagnosed by ultrasonography.

What are the difficulties in diagnosis? Misdiagnosis in the early weeks of pregnancy can lead to a wrong termination of a normal pregnancy. In addition, a late diagnosis at 9 or 10 weeks of gestation or later can lead to a missed diagnosis of a true scar pregnancy.

Experience is the most important factor in diagnosing a caesarean scar pregnancy.

Isevery scar pregnancy a true scar pregnancy?

No. Some are normal pregnancies. A true scar pregnancy is often confused with a low-lying sac.

Is a gestational sac located at the site of a caesarean section (incision) a scar pregnancy or does it progress to a scar pregnancy? Not every gestational sac located in the lower part of the uterus is a scar pregnancy. Not every gestational sac located below the uterus progresses to a scar pregnancy.

Unfortunately, very early in pregnancy, such as in the 5th or 6th or even 7th week of pregnancy, a gestational sac that is located in the lower part of the uterus, that is, in the place of the cesarean incision, is mistakenly considered as a cesarean scar pregnancy all over the world.

The trick is to understand whether the placenta, not the gestational sac, is located at the cesarean incision site; however, this is not very easy because the diagnosis of scar pregnancy is difficult due to the early formation of the placenta.

Our experience: Since our center has diagnosed and followed up more than 100 cesarean scar pregnancies and delivered these pregnancies, our opinion is that in some cases, even if the placenta implants at the cesarean incision site, it does not progress to placental adhesion anomaly (placenta percreta) in the following weeks of pregnancy.

It is possible to reach a final decision after close follow-up of these cases.

Moreover, even if the scar pregnancy turns into placenta percreta, considering that the uterus will not be removed in every case of percreta, it is necessary not to terminate pregnancies very willingly.

Some cases who came to our clinic or received information by phone reported that their pregnancies were terminated because they were diagnosed with scar pregnancy and that they could not conceive again despite their strong desire. In short, those who do not perform scar pregnancy or placenta percreta surgery should not mislead patients.

Does every scar pregnancy become placenta percreta?

No.

Not all scar pregnancies progress to placenta percreta, a more severe adhesion anomaly, in the following weeks. Even if it progresses, not all cases of placenta percreta require hysterectomy, i.e. uterine-sparing placenta percreta surgery. In severe cases of percreta, hysterectomy is difficult and requires advanced surgical experience.

NOTE: We do not guide our patients with only literature or classical book knowledge. Our knowledge consists of the follow-up of around 600 cases of percreta (and an average of 100of these cases are scar pregnancies). The number of centers in the literature or in the world reaching these numbers is very limited. Therefore, if the existing scar pregnancy is a very desirable pregnancy, it should be given a chance of pregnancy and its management should be well planned. Because the same pregnant woman may not have a chance of pregnancy later on. Planning and management should be family-specific.

Danger in diagnosis: In the early weeks of pregnancy, the diagnosis may be misleading; in the later weeks of pregnancy, the diagnosis of a severe scar pregnancy may be missed.

Planning should not be made without the family’s expectations and conditions and good follow-up.

Caesarean section for scar pregnancy: Usually laparoscopic surgery is performed; a good repair should be done laparoscopically in consideration of subsequent pregnancies.

In large cases with advanced gestational age, laparotomy is more logical for a better repair.

Can scar pregnancy occur again after scar pregnancy?

It can happen.

Therefore, when terminating a pregnancy, many factors such as the expectations of the family, the age of the patient, how much the family wants the current pregnancy or what the chances of the next pregnancy may be should be discussed with the family repeatedly, the ideal way should be chosen and comprehensive counseling should be given.

Note: The diagnosis, treatment, follow-up and management of scar pregnancy should be patient-specific, well planned and counseled.