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Cesarean Scar Pregnancy: A Baby Placenta Accreta

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Abstract

Cesarean scar pregnancy (CSP) is a serious, iatrogenic, and late consequence of a previous cesarean delivery (CD), which may result in clinical complications throughout all three trimesters of the pregnancy when unrecognized or untreated. Its rate of occurrence parallels the number of CDs. If untreated, it may progress and result in a live offspring; however, it is the main cause of morbidly adherent placentae in the late second and in the third trimesters of the pregnancy.

The last 40 years witnessed a steady increase in cesarean deliveries (CD). Very few paid attention that hand-in-hand with the already high but somewhat stabilized rate of CDs, cases of placenta accreta/increta/percreta lately mentioned under a general term placenta accreta spectrum (PAS) as well as cases of cesarean scar pregnancy (CSP) earned increasing attention. Even fewer realized the connection between CSP and PAS. Slowly, during the last 20 years, but definitely in the last 10 years, the connection between CSP and degrees of PAS was recognized and became the subject of increased scrutiny and research. Understanding CSP as the proven precursor of PAS can lead to its planned management, reducing their numbers and maybe even preventing its occurrence. In the last several years, the subject of CSP and PAS constituted the fastest increase in the number of publications in the obstetrical and gynecologic literature. This chapter addresses the diagnostic, differential diagnostic algorithms and sonographic definitions of CSP. It also provides a detailed overview of the treatment protocols found in the literature emphasizing their success as well as their failure rates, which are reflected by their possible but avoidable complications. The text also includes the suggested counseling approach to patients with early diagnosis of CSP that may be useful in patient management.

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Authors and Affiliations

  1. Division of Obstetrical and Gynecological Ultrasound and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA

    Ilan E. Timor-Tritsch, Ana Monteagudo & Terry-Ann Bennett

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  1. Ilan E. Timor-Tritsch
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  2. Ana Monteagudo
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  3. Terry-Ann Bennett
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Correspondence to Ilan E. Timor-Tritsch .

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  1. University of Chicago, Chicago, IL, USA

    Jacques S. Abramowicz

  2. University of Chicago, Chicago, IL, USA

    Ryan E. Longman

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Timor-Tritsch, I.E., Monteagudo, A., Bennett, TA. (2023). Cesarean Scar Pregnancy: A Baby Placenta Accreta. In: Abramowicz, J.S., Longman, R.E. (eds) First-Trimester Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-24133-8_18

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