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Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided written consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP-related complications. [ABSTRACT FROM AUTHOR]

Objectives. Currently, there is no established gold standard for the treatment of caesarean scar pregnancy (CSP). This study aims to propose a new standard of care for managing CSP. Caesarean scar pregnancy is classified into two types: type 1 (on the scar) and type 2 (in the niche). There is currently no international standard for predicting invasion extent or for determining the most effective management approach for CSP. Materials and method. Our protocol involved intramuscular methotrexate injection, followed by uterine artery embolization and suction evacuation as part of a conservative approach. This protocol was applied to seven patients diagnosed with CSP. Only patients with caesarean scar pregnancy at an early gestational age (≤9 weeks) who provided writ ten consent for the combined treatment method were included. Results. All cases had positive outcomes, without any complications such as uterine perforation, emergency hysterectomy, severe hemorrhage or endometritis. Early diagnosis of CSP and the location of invasive trophoblast opposite the uterine scar were significant predictors for a favorable outcome. Conclusions. This series of CSP cases demonstrates that the combination of systemic methotrexate and uterine artery embolization ensures effective and minimally invasive management of caesarean scar pregnancy. This treatment protocol is suitable for both types of CSP. The early identification of pregnancy location, particularly after caesarean delivery, should be mandatory to prevent CSP related complications. [ABSTRACT FROM AUTHOR]

Transvaginal ultrasound and serum concentration of human chorionic gonadotropin are the main methods of prognostic evaluation of early pregnancies. Although these pregnancy investigation methods have proven their benefits, the interpretation is fundamental for a correct diagnosis, in order to avoid interventions that may affect pregnancies that would normally have had a physiologic course, as well as to apply an appropriate management in the case of nonviable pregnancies. Recent studies have shown the need to adopt rigorous criteria that minimize false positive results and thus decrease the frequency of diagnostic errors. Over time, a series of ultrasound features have been described which have proven effective in predicting nonviable pregnancies in the first trimester (cranio-caudal length in relation to the presence or absence of cardiac activity, yolk sac diameter, gestational sac diameter in relation to presence or absence of embryo with cardiac activity, embryonic heart rate, subchorionic hematoma etc.). In the context of the new prospects for the development of artificial intelligence softwares, the present work focuses on the description of the precise ultrasonographic aspects aboded by the latest studies that propose certain cut-off values dependent on the gestational age of the ultrasound parameters in the first trimester, increasing the sensitivity and the specificity of ultrasound in the diagnosis of nonviable early pregnancies, thus aiming to improve the reproductive prognosis of couples with recurrent abortions. [ABSTRACT FROM AUTHOR]