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

Abstract

ObjectivesTo evaluate cesarean scar using saline‐infused sonography (SIS) in women with a history of cesarean scar pregnancy (CSP).MethodsA cohort of 38 non‐pregnant women with a history of CSP treated with combined local and systemic methotrexate (MTX) were prospectively investigated by SIS. For purposes of analysis, they were classified according to the new Delphi Consensus Criteria for CSP in early gestation into three subgroups based on the depth of the gestational sac herniation in the sagittal plane. Subgroup A included 8 (21.1%) cases in which the largest part of the gestational sac protruded towards the uterine cavity. Subgroup B included 20 (52.6%) cases in which the largest part of the gestational sac was embedded in the myometrium, and subgroup C included 10 (26.3%) cases in which the gestational was partially located outside the outer contour of the cervix or uterus.ResultsAll subgroup C women were revealed to have a uterine niche during SIS. The median niche length (p=0.006) and depth (p=0.015) were significantly greater in subgroup C than in subgroups A or B. The median residual myometrial thickness (RMT) was significantly lower in subgroup C than in subgroups A or B (p=0.006).ConclusionsWomen with prior CSP who had a gestational sac protruding beyond the serosal line had a significantly greater niche length, depth and lower RMT and may contribute to individualized risk counselling.This article is protected by copyright. All rights reserved.