If a woman has a first-trimester diagnosis of a cesarean scar implantation pregnancy and embryonic cardiac activity is present, expectant management offers the possibility of delivering a live-born neonate (62.5% in our study) but carries a substantial likelihood of hysterectomy at delivery due to placenta accreta (37.5% in our study), whereas minimally invasive therapy that interrupts the pregnancy largely eliminates the need for hysterectomy.
We have described nonsurgical and surgical treatments of first trimester CSP with a low rate of major complications and no emergent hysterectomies. Of the nonsurgical therapies, single-agent treatment with either systemic MTX or intrasac KCl was associated with high rates of needing additional treatment and should be avoided. Our method of ultrasound-guided suction D&C resulted in no major hemorrhage and is a reasonable surgical treatment option.
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