A case series on cesarean scar pregnancy: Diagnostic and therapeutic challenges in early gestation

Cesarean scar pregnancy (CSP) is a rare and potentially life-threatening form of ectopic pregnancy, increasingly encountered due to rising cesarean rates and improved early pregnancy imaging. This case series presents seven patients diagnosed with CSP between 5 and 8 weeks of gestation, each managed with individualized strategies based on clinical presentation, serum β-hCG levels, gestational sac size, and fetal cardiac activity. Diagnosis was made through transvaginal ultrasound and confirmed by serum β-hCG measurements. Six patients were managed successfully with methotrexate (MTX), including 3 patients with additional intracardiac potassium chloride (KCl) injection and three requiring a second MTX dose due to slow biochemical resolution. One patient underwent surgical excision due to large sac size. No patient experienced uterine rupture or required hysterectomy. This series emphasizes the importance of early diagnosis and individualized management in CSP to ensure favorable outcomes and preserve fertility.