الفهرس 
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Abstract
Cesarean scar pregnancy is an increasing challenge worldwide.
Caesarean scar pregnancies are a rare obstetric complication, resulting from implantation of an embryo on previous cesarean scar, but there has been a surge of reports in the medical literature in the past decade, prompted by the increase in occurrence secondary to the seemingly inexorable rise in caesarean deliveries.. It can be devastating because of complications such as uterine rupture and massive hemorrhage, leading to increased maternal morbidity and mortality.
Implications for clinical practice Increasing CD rates over the past two decades and advances in prenatal imaging have led to an increase in the number of patients with CSP requiring obstetric management.
Despite the high burden of maternal morbidity associated with this condition, CSP is commonly misdiagnosed.
Diagnosis is facilitated with better imaging facilities, but it needs a high index of suspicion and clinical awareness.
TVU has the main role of diagnosis, Recently, another ultrasonography marker, cross-over sign (COS), has been recommended Likewise for those who are having possibility for AIP, in order to stratify ladies with CSP as stated by probable seriousness from AIP.
The fundamental pathophysiology is believed to be blastocyst invasion of the myometrium through a microtubular tract between the caesarean section scar and the endometrial canal. The blastocyst is therefore completely surrounded by myometrium and fibrous tissue of the scar, completely separated from the endometrial cavity.
Another reason for the increase in CSP may be due to the frequency of abortions that lead to endometrial and myometrial trauma.
Although being serious, emerging complication there’s no consensus on the preferred treatment modality for CSP; proper assessment and individualization of treatment is the key for best results with the least risk of complications of the increasingly rising rates of CS.
Treatment for CSP should be individualized and chosen based on patient’s conditions, body signs and lab results.
Treatment modalities are either medical or surgical, and there is no consensus on the preferred mode of treatment. Medical treatment involves systemic or local administration of methotrexate (MTX), potassium chloride,, mifepristone.
Primary surgical treatment options for CSP in patients wishing to preserve fertility include uterine curettage, hysteroscopic resection, laparoscopic resection, and laparotomy with resection. Optimal treatment choice depends on factors such as pregnancy size, the haemodynamic status of the patient, absence or presence of scar rupture, hCG levels, and desire for future fertility.
The aim of this study is to identify the clinical presentations, determinants of management and management outcomes in presenting our experience with this condition over a 5-year period in Ain Shams University maternity hospital.
All patients diagnosed with CS ectopic pregnancy were included in the study.
Patients included had been diagnosed with Cesarean scar ectopic pregnancy between 4-9 weeks from LMP. Age of the patients 18-40 years old. Previous 1cs at least