A 27-year-old woman with a previous cesarean scar has 7 weeks amenorrhea, a positive pregnancy test, and ultrasound shows a gestational sac implanted in the lower anterior uterine segment at the scar site with no fetal heartbeat. β-hCG is 12,500 IU/L. This is a cesarean scar pregnancy (CSP). According to the Vial classification, this particular type where the sac is embedded deeply in the scar with risk of uterine rupture is:
- A Type 1 CSP (endogenous type)
- B Type 2 CSP (exogenous type) ✓
- C Type 3 CSP (hybrid type)
- D Cervico-isthmic pregnancy
Explanation
The Vial classification of cesarean scar pregnancy describes two types: Type 1 (endogenous) where the sac grows toward the endometrial cavity with potential to develop into a live birth but high risk of abnormal placentation; Type 2 (exogenous) where the sac grows deeply into the myometrium/scar toward the bladder and serosa, with high risk of uterine rupture and severe hemorrhage. Type 2 is the more dangerous form requiring urgent intervention. Treatment options include systemic methotrexate, ultrasound-guided local injection, uterine artery embolization, or hysteroscopic resection depending on institutional expertise and patient hemodynamics.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.