Cesarean Scar Pregnancy Diagnosed in the First Trimester: A Report of Two Cases and Literature Review

Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy characterized by implantation of the gestational sac within a previous cesarean section scar. Its incidence has increased in parallel with rising global cesarean delivery rates. Early diagnosis is critical to prevent life-threatening complications such as uterine rupture and severe hemorrhage. We report two first-trimester CSP cases. The first involved a 30-year-old woman with three previous cesarean sections presenting with pelvic pain and hemoperitoneum. Emergency laparotomy with excision of the gestational tissue and uterine scar repair was performed. The second case concerned a 37-year-old woman diagnosed early by transvaginal ultrasound and successfully treated with a two-dose systemic methotrexate regimen, achieving complete biochemical and sonographic resolution. Transvaginal ultrasound is the cornerstone of CSP diagnosis. Management options include systemic or local methotrexate, hysteroscopic or laparoscopic resection, uterine artery embolization, or laparotomy in unstable patients. Treatment must be individualized according to hemodynamic status, gestational age, beta-human chorionic gonadotropin (β-hCG) level, myometrial thickness, and future fertility desire. CSP requires early recognition and tailored management. These cases illustrate the variability in clinical presentation and emphasize the importance of first-trimester ultrasound evaluation in women with previous cesarean deliveries.