Methods: This study retrospectively described all cases of cesarean scar pregnancy diagnosed and managed at a tertiary care center over a 3-year period. Maternal demographics, clinical presentation, treatment methods, and outcomes were all included in the analysis.

Results: uring the study period, 5 cases of cesarean scar pregnancy were diagnosed and managed. The median gestational age at diagnosis was 8 weeks, and all fetuses had positive cardiac activity. All cases were initially treated with systemic intramuscular (IM) methotrexate (MTX), but only one case responded well due to fetal bradycardia present prior to treatment. One patient received further management with transvaginal intracardiac potassium chloride (KCL) injection, which resulted in maternal sepsis, hemorrhage, and ICU admission. The other 3 cases were managed by transabdominal intra-gestational sac MTX +/- KCL and showed good clinical response. Two of these cases required an interval dilation & curettage (D&C) due to persistent vaginal spotting with no complications.

Conclusions: It is recommended to avoid using systemic IM MTX as the first-line treatment for scar pregnancy unless the pregnancy is failing or non-viable. Intra-gestational sac treatment may cause persistent retained products of conception, leading to bothersome vaginal spotting. An interval ultrasound guided D&C appears to be safe for managing this complication, but the exact interval needs to be determined through further studies. Sepsis is a rare complication of invasive medical treatment, and close surveillance is advised.