Objectives: To analyse the incidence, presentation, diagnosis, treatment modalities and follow up of patients with Caesarean Scar Ectopic Pregnancy (CSEP) in a tertiary care referral hospital between 2012 and 2017.

Methods: A total of nine cases were identified by retrospective analysis of case records and operation theatre registers and patients were followed up for complications and future pregnancies.

Results: The incidence in our study was 1:1200 which is higher when compared to studies reported in literature (1:1800-1:2200). 6 patients had a definitive diagnosis of CSEP whereas 3 of them had been treated as intrauterine pregnancies and evacuation attempted resulting in profuse haemorrhage. The gestational age at presentation ranged from 5-8 weeks and cardiac activity was detectable in 3 of the cases. The interval between the antecedent caesarean section and the CSEP varied between 1-10 years. The treatment modalities offered include systemic methotrexate, selective uterine artery embolisation, ultrasound guided evacuation, resection by laparotomy with one patient managed by hysterectomy following catastrophic bleeding. 8 of the 9 patients had more than one mode of management whereas one patient was managed by methotrexate alone. Surgery was the commonest management modality (8 cases) followed by uterine artery embolisation (4 cases). 5 patients had emergency surgery whereas 3 of them had elective resection following failed medical therapy. 2 patients underwent concurrent sterilisation during scar excision. One patient who underwent scar excision conceived 2 years later, had an uneventful pregnancy and delivered at term by elective caesarean section. All the patients had an uneventful postoperative period.

Conclusion: With the increasing incidence and rise in awareness amongst healthcare professionals regarding the diagnostic criteria of CSEP, complications due to misdiagnosis/delayed diagnosis could be reduced significantly. There is no single best treatment option for CSEP; management has to be individualised. More studies with larger numbers might be needed to frame guidelines for uniform management.