Role of Sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies

Objective. Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotnexate (MTX) into the gestational sac. Methods. Two patients with CSEPs were treated with systemic and intra-amniotic administration of MTX under sonographic guidance. Results. Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. Conclusions. Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.