Identifying possible risk factors for cesarean scar pregnancy based on a retrospective study of 291 cases

Abstract

Aim: Cesarean scar pregnancy (CSP) is a rare but life-threatening type of ectopic pregnancy. This study's aim is to investigate the clinical characteristics and possible risk factors for cesarean scar pregnancy. Methods: A clinically randomized, unpaired and retrospective case-control study was implemented. A study group of 291 CSP patients and a control group of 317 full-term pregnant women with a history of cesarean section (CS) were recruited in our hospital from May 2013 to October 2018. Their demographic characteristics and medical and obstetric history were collected. Results: Only symptoms suggestive of an impending abortion, such as vaginal bleeding with or without abdominal pain, were identified as the clinical characteristics of CSP. Maternal age older than 35 years, gravidity higher than 3 (especially gravidity higher than 5), more than two induced abortions (especially more than five abortions), an interval of less than 5 years (especially less than 2 years) between the current pregnancy and the last CS, history of CS performed in a rural hospital, history of induced abortions after CS and retroposition of the uterus were possible independent risk factors for CSP. Conclusion: CSP is a result of a combination of multiple factors associated with CS. There are no unique early clinical features of CSP. As a unique type of ectopic pregnancy, early diagnosis, early termination and early clearance should be the treatment principles. Further research is needed to evaluate the relationship between the cesarean scar defect and CSP in the future.

The Importance of Ectopic Mindedness: Scar Ectopic Pregnancy, a Diagnostic Dilemma

“…Damage to the uterine endometrial or myometrial layer is the predisposing factor [ 2 ]. In a retrospective study of 291 cases by XianYi et al, the other predisposing or independent risk factors for cesarean scar pregnancies are : age more than 35 years, multigravida, cesarean sections performed in a rural setting, history of induced abortions after cesarean sections, and retroverted uterus [ 3 ]. Interestingly, increase in probability of scar pregnancy has no correlation to the number of earlier cesarean sections in the individual.…”

Use of Magnetic Resonance Imaging (MRI) in the Management of Diagnostic Uncertainty in Low-Resource Settings: A Case Report of Cesarean Ectopic Pregnancy in a Tertiary Hospital in Ghana

“…Risk factors for the development of CSEP include multiparity, advanced maternal age, history of multiple cesarean sections, history of multiple induced abortions, and iatrogenic uterine defect [ 29 ]. In vitro fertilization and fertility-conserving myomectomies for fibroids are also important risk factors [ 30 ].…”

“…In vitro fertilization and fertility-conserving myomectomies for fibroids are also important risk factors [ 30 ]. During the first 5 years after the last cesarean section, there is an increased risk for CSEP, with the highest risk in the first 2 years [ 29 ]. CSEP risk factors may have compounding effects [ 29 ].…”

“…During the first 5 years after the last cesarean section, there is an increased risk for CSEP, with the highest risk in the first 2 years [ 29 ]. CSEP risk factors may have compounding effects [ 29 ]. As in our case, women with a history of cesarean section before the onset of labor are most at risk for CSEP because of the poor development of the lower uterine segment [ 23 ].…”

Fecundity disorders in older women: declines in follicular development and endometrial receptivity

“…In recent years, later-age childbearing has become a trend in China, particularly as more women have steadily entered the workforce. In addition, with the implementation of the two-child policy in China, the number of older women (≥35 years) who desire pregnancy is gradually increasing [1]. However, fecundity declines significantly beginning at approximately 32 years of age and decreases more rapidly after 37 years of age because of a decrease in egg quality and a gradual increase in the circulating level of follicle-stimulating hormone (FSH) [2].…”