Caesarean scar pregnancy: is there a light in the end of the tunnel?

Abstract

Purpose: to summarize and present a single tertiary center's 25 years of experience managing patients with caesarean scar pregnancies and their long term reproductive and obstetric outcomes.Methods: A 25-year retrospective study included women diagnosed with CSP from 1996 to 2020 in one tertiary center. Data were retrieved from the medical records and through a telephone interview. Diagnosis was made by sonography and color Doppler. Treatments included methotrexate, suction curettage, hysteroscopy, embolization and wedge resection by laparoscopy or laparotomy as a function of the clinical manifestations, the physicians' decisions, patient counseling, and parental requests.Results: Analysis of the records recovered 60 cases of CSP (two of whom were recurrent). All patients had complete resolution with no indication for hysterectomy. Thirty-ve patients had a long-term follow-up, of whom 24 (68.6%) attempted to conceive again and 22 (91.6%) succeeded. There were 17/22 (77.3%) patients with at least one live birth, 3/22 (13.6%) spontaneous miscarriages and 2/22 (9%) recurrent CSP.The obstetric complications included abnormal placentation 5/19 (26.3%), premature rupture of membranes 2/19 (10.5%), preterm delivery 4/19 (21%) and abnormality of the uterine scar 2/19 (10.5%).There was one case of neonatal death due to complications of prematurity 1/19 (5.2%).Conclusion: CSP treatment focusing on reducing morbidity and preserving fertility has favorable long term reproductive and obstetric outcomes. In subsequent pregnancies, we recommend performing an early rst trimester vaginal scan to map the location of the new pregnancy, followed by close monitoring given the obstetric complications mentioned above.

Evaluation of Cesarean section scar using saline contrast sonohysterography in women with previous Cesarean scar pregnancy

“…Using the classification proposed by the CSP taskforce 23 , we found that all women with a history of CSP in which the gestational sac protruded over the serosal line in the midsagittal plane presented with a uterine niche on SCSH and were more likely to have greater niche length and depth, and smaller RMT than those who had the largest part of the gestational sac protruding towards the uterine cavity or embedded in the myometrium. Overall recurrence rate in women with previous CSP can vary across studies (9-25%) [24][25][26][27] . Timor-Tritsch et al 28 found a higher rate of 34.3% and Ben Nagi et al 29 argued that a very large niche could be the cause of CSP after CD.…”

“…Overall recurrence rate in women with previous CSP can vary across studies (9–25%) 24–27 . Timor‐Tritsch et al 28 .…”

Outcomes of Cesarean Scar Pregnancies in Early Gestation According to the New Delphi Consensus Criteria

“…Hence our department's current policy is to recommend termination of these pregnancy as soon as the diagnosis is made. 26 The Society for Maternal-Fetal Medicine (SMFM) recently recommended pharmacological treatment by local or intragestational injection of MTX with or without accompanying systemic MTX for those women who are eligible. 27 Systemic MTX alone is discouraged, given the higher risks of complications.…”

“…However, in our experience, 2,3 the prognosis for an uneventful term pregnancy remains extremely poor. Hence our department's current policy is to recommend termination of these pregnancy as soon as the diagnosis is made 26 …”