Cesarean scar pregnancy: a ten-year single center experience

Abstract Introduction: Cesarean scar pregnancy (CSP) is a rare but potentially life-threatening form of ectopic pregnancy which incidence has been constantly raising during the last decades. The aim of this study was to describe the epidemiological characteristics of CSP in our population and to investigate the impact of different treatments on the maternal outcomes and prognosis. Patients and methods: This was a retrospective study including all patients diagnosed with CSP and who were admitted in our maternity between January 2010 and December 2020. Data were collected from the patients’ medical records. We compared outcomes (hospital stay duration, serum BHCG levels, complications, new pregnancy) in 2 groups: group 1 was treated with systemic injection of methotrexate (MTX) associated with dilatation curettage (DC) and group 2 was managed with uterine artery embolization (UAE) and DC. Results: The mean age was 33.5 years old. Most of patients (80%) reported history of 2 or more previous cesarean sections. The mean gestational age at diagnosis was 8 weeks. Patients presented mostly with isolated amenorrhea. The mean βHCG serum level at admission was 52352.4 milliunits/mL. The diagnosis was made on ultrasonographic examination in all cases. The Management of CSP in group 1 was associated with a significantly shorter resolution time of serum βHCG levels (p = 0.006). A shorter hospital stay duration was also reported in group 1 but with no statistical significance (p = 0.31). Complications were more observed in group 2 but with no statistical significance (p = 0.61). Conclusion: We concluded that UAE associated with an ultrasound-guided DC might be an interesting option for the management of CSP. An early and appropriate diagnostic with identification of cases at higher risk is necessary to reduce complications.