Risk Factors Associated With Failure of Initial Treatment for Cesarean Scar Pregnancy

This study aimed to provide reference for CSP treatment. It’s a cohort study. Ultrasound-guided evacuation, hysteroscopy-guided evacuation and uterine artery embolization were used during the initial treatment. The treatment methods failed in 77 of the CSP patients (study group). 1560 of the CSP patients were treated successfully (control group). Multivariate logistic regression analysis found that in model 1, distance between gestational sac and serosal layer (OR: 0.04, 95%CI: 0.00–0.82, p= 0.037) and fetal heartbeat (OR: 8.91, 95%CI: 3.81–20.81, p= 0.000) are risk factors for CSP initial treatment failure. Model 2 showed that gestational age (OR: 0.96, 95%CI: 0.92–1.00, p= 0.043) and fetal heartbeat (OR: 2.15, 95%CI: 1.02–4.52, p= 0.000) are the risk factors. Model 3 indicated that mean sac diameter (OR: 1.56, 95%CI: 1.21–2.01, p= 0.001), fetal heartbeat (OR: 4.75, 95%CI: 2.23–10.14, p= 0.000) and pretreated with UAE (OR: 5.05, 95%CI: 2.36–10.83, p= 0.000) are risk factors. In model 4, fetal heartbeat (OR: 2.87, 95%CI: 1.28–6.42, p= 0.010) and pretreated with UAE (OR: 4.24, 95%CI: 1.98–9.07, p= 0.000) are the risk factors. In conclusion, for CSP patients with different treatment, if the relevant risk factors exist, it should be more cautious.