Abdullah Aldawsari
Prince Sultan Military Medical City, Saudi ArabiaPresentation Title:
Cesarean scar ectopic pregnancy: Clinical risk factors, management strategies, and outcomes- A two-year experience at Prince Sultan Military Medical City, Riyadh
Abstract
Background: Cesarean Scar Ectopic Pregnancy (CSEP) is a rare but potentially life-threatening form of ectopic pregnancy, occurring when the gestational sac implants within a previous cesarean scar. The increasing global rate of cesarean deliveries has led to a parallel rise in CSEP incidence, emphasizing the need for early recognition and standardized management strategies.
Objective: This study aimed to evaluate the clinical features, risk factors, management modalities, and outcomes of patients diagnosed with CSEP at Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
Methods: A retrospective review was conducted of all CSEP cases managed at PSMMC between January 2022 and December 2023. Data collected included maternal demographics, obstetric history, presenting symptoms, diagnostic imaging findings, therapeutic approaches, and clinical outcomes. Treatment modalities were categorized into medical (systemic or local methotrexate), surgical (laparoscopic or hysteroscopic removal), and combined approaches.
Results: A total of 28 patients were included. The mean maternal age was 33 ± 4.2 years, with 89% having a history of more than one cesarean delivery. Vaginal bleeding was the most common presenting symptom (78.5%), followed by pelvic pain (64.2%). Ultrasound with Doppler confirmed diagnosis in all cases. Medical management with methotrexate alone achieved successful resolution in 57% of patients, while 29% required surgical intervention due to persistent trophoblastic activity or heavy bleeding. Overall, the treatment success rate was 85.7%, and no cases of uterine rupture or maternal mortality occurred.
Conclusion: Early diagnosis and individualized treatment selection are crucial for successful outcomes in CSEP. Methotrexate therapy remains effective for hemodynamically stable patients, whereas minimally invasive surgical approaches are valuable for selected cases. Heightened awareness among clinicians and routine evaluation of cesarean scars in early pregnancy are key to preventing severe complications.
Biography
Abdullah Aldawsari is an assistant consultant in the department of obstetrics and gynecology at Prince Sultan Military Medical City in Riyadh, Saudi Arabia. He obtained the Saudi board in obstetrics and gynecology in 2022 after completing his residency training under the Saudi Commission for health specialties. His main areas of interest include high-risk pregnancy and minimally invasive gynecologic surgery. He has been involved in several clinical research projects, including studies related to cesarean scar ectopic pregnancy and the management of rare obstetric conditions. He participates regularly in educational and academic activities and is keen on improving patient care through evidence-based clinical practice. He aims to continue developing his clinical and research skills to contribute to the advancement of women’s health services.
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