Case of a Cesarean Scar Pregnancy Resulting in a Live Birth After in Vitro Fertilization

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy in which a fertilized embryo implants into the cesarean section scar on the anterior uterine wall. CSP occurs more frequently after assisted reproductive technology (ART) than after spontaneous conception; therefore, understanding the relation between ART and CSP is crucial for appropriate pregnancy management. Because CSP may lead to severe complications, termination of pregnancy during the first trimester is often selected. However, when continuation of the pregnancy is desired, management becomes challenging.

We report a case of CSP following in vitro fertilization and embryo transfer. The patient chose to continue the pregnancy. Magnetic resonance imaging at 19 weeks and 1 d revealed findings suggestive of placenta accreta (also referred to as placenta creta) at the cesarean scar site. Magnetic resonance imaging at 29 weeks and 1 d showed complete replacement of the anterior myometrium by the placenta. At 32 weeks and 3 d, an elective cesarean section and total hysterectomy with bilateral salpingectomy were performed under multidisciplinary management. The placenta was completely attached to the scar area but did not invade adjacent organs, confirming placenta accreta. Both maternal and neonatal outcomes were favorable.

Despite high risks associated with continuing a CSP pregnancy, outcomes can be favorable when management is carefully planned and individualized. Given the increasing prevalence of ART, clinicians should remain aware of the risk of CSP in patients with prior cesarean delivery and focus on early recognition, comprehensive imaging evaluation, and personalized management strategies to ensure optimal maternal and neonatal outcomes.