Abstract
Progression of a caesarean scar ectopic pregnancy (CSEP) to a live birth is exceptionally rare. Whether the placenta should be removed during a caesarean section for patients with a CSEP complicated by severe placenta accreta spectrum remains unclear. This report presents the case of a 42-year-old multigravida with two prior caesarean sections who presented with CSEP at 6 weeks. Despite recommendations for termination, the patient decided to continue the pregnancy. Serial imaging confirmed a progressive placenta accreta spectrum. At 34+ weeks of gestation, a caesarean hysterectomy was successfully performed under the management of a multidisciplinary team, with good maternal and infant outcomes. The management of a CSEP progressing to a live birth during the third trimester requires provider expertise and multidisciplinary treatment and should be individualized. In the present case, caesarean hysterectomy was performed without attempting placental removal, which might have significantly decreased blood loss. While the patient survived, the management remains controversial, and women with CSEP opting for expectant management should be informed about the lack of conclusive evidence on its safety and associated risks. Such options can be considered only in a highly equipped specialist centre with access to a multidisciplinary team.