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107 Maternity and Obstetrics Caesarean Scar Pregnancy Caesarean scar pregnancy (CSP) is a common precursor to severe PAS and both conditions exist as part of a common disease spectrum. The true incidence of CSP is unknown with reported rates in literature varying from 1:800 to 1:2656. Although relatively uncommon its incidence is increasing in line with increasing caesarean section rates. During 2020, 6 patients with CSP where discussed at the multi-disciplinary team meeting. Gestation at diagnosis ranged from 5+2 – 11+1 weeks gestation. 83% of patients were asymptomatic at diagnosis. (n=5) with only one case presenting with early pregnancy bleeding. The most common risk factor associated with CSP was a history of 1 previous LSCS. 1 patient with a history of a previous CSP continued her pregnancy. PAS was diagnosed and she underwent elective caesarean hysterectomy at 31+6 weeks gestation in a general hospital (patient 1 table 1 and 2). 5 patients underwent ERPC all performed under ultrasound (US) guidance. One patient developed a post-operative scar haematoma and had a laparotomy and excision of scar 6 months later and an MRI performed 3 months after repair demonstrated an excellent anatomical result. Table 2: Caesarean Scar Pregnancy Overview Age Parity RF Gestation Management EBL ml Outcome 1 33 2+1 1 x ERPC Previous CSP 1 x LSCS 6+1 Continued pregnancy PAS 1500 Caesarean hysterectomy @ 31+6 with IR support 2 36 1+0 1 x LSCS 11+1 ERPC US Guidance 2000 Scar haematoma post op MRI follow up Excision of scar niche via laparotomy 3 42 1+3 1 x LSCS 2 x ERPC IVF 7+3 ERPC US guidance 50 MRI 3/12 and GOPD 4 40 3+0 2 x LSCS 5+2 ERPC US guidance 100 MRI 3/12 GOPD 5 34 1+2 1 x LSCS 1 x ERPC 9+2 ERPC us guidance 100 MRI 3/12 Recurrent miscarriage clinic 6 37 1+0 1 x LSCS 7+3 ERPC – unsuccessful Methotextrate x 2 Serial bhcg n/a Follow up Letterkenny NMH Annual Rep t | 2020