Cesarean scar pregnancy (CSP) is a potentially dangerous consequence of a previous cesarean section (CS) [1,2]. The incidence of scar pregnancy is increasing because of the increased frequency of CS and probably thanks to the improvement in ultrasound diagnosis [3,4]. The occurrence of CSP is related to frequency of CS and its true incidence is unknown with approximated incidence between 1/1800 and 1/2500 CS performed [5]. CSP is a type of ectopic pregnancy characterized by the implantation and growth of gestational sac on the scar of a previous CS at the anterior uterine wall. It can facilitate abnormal placentation, causing potential sever morbidity that increases with the advancing of the pregnancy [6], [7], [8]. CSP, occurs when the blastocyst penetrates in the tract of uterine scar which follows a CS, with an uncontrolled trophoblast's penetration in the portion of the uterus lacking decidua [1,9]. There are two different types of CSP. Endogenous type I is due to the implantation of gestational sac extended into the uterine cavity or the cervical-isthmic space, which may allow a viable birth but at a high risk of massive bleeding resulting from placental implantation or uterine rupture. Exogenous type II refers to deep implantation of the conceptus with possible penetration in the abdominal cavity and the bladder, resulting in uterine rupture and intraperitoneal hemorrhage during the early trimester of pregnancy [10]. It is also documented that CSP has strong relationship with placenta accreta spectrum (PAS) in the case that pregnancy is not terminated [11]. The diagnosis is not easy and accomplished with many cases of misdiagnosis with sharp curettage for presumed simple miscarriage resulting in bleeding and emergency surgical interventions [2]. If undiagnosed and untreated CSP could lead to hemorrhage, uterine rupture and need for hysterectomy [2]. In general, if CSP is diagnosed, pregnancy should be ended as soon as possible to avoid serious women morbidity and mortality. Several treatments (more than thirty) are available: local or systemic methotrexate, chemoembolization or several kinds of surgical evacuation [4,9]. It is also possible to opt for a wait-and-see management until the third trimester, carefully weighing the risk-benefit ratio, because this management is associated with 70 % of hysterectomy cases [4]. The best treatment has not yet been clarified and depends on center and operator preferences [9]. The safest and most effective management of CSP is still matter of debate, being most of the studies on CSP treatment case series or non-randomized trials, [5,6] but an early diagnosis and treatment would seem to be essential as outcomes and complications worsen significantly after 9 weeks of gestation [8].

The aim of this study is to investigate the effectiveness, safeness and complication rates of combined ultrasound guided suction curettage of CSP followed by cervical-isthmic placement of three-way foley catheter.