Cesarean scar pregnancy: problem-solving methodologies and approaches

This article discusses the epidemiology, classification, diagnosis, and treatment of cesarean scar pregnancy (CSP). The main ultrasound signs of CSP and their significance in choosing a treatment strategy are presented, which depends on many clinical and anamnestic factors, namely: the type of CSP, gestational age, residual myometrial thickness, and the degree of ectopic trophoblast invasion into the surrounding tissues. A number of aspects related to hemostasis in CSP are critically analyzed. In particular, it is shown that transvaginal ligation of the descending branch of uterine artery is more effective in terms of hemostasis compared to uterine artery embolization in CSP with mild invasion of chorionic villi into the myometrium. The role of operative hysteroscopy in the treatment of patients with CSP is analyzed in detail. The material is supplemented with a clinical case report. © 2025 Elsevier B.V., All rights reserved.