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

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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-five 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 encouraging long-term reproductive and obstetric outcomes. In subsequent pregnancies, we recommend performing an early first trimester vaginal scan to map the location of the new pregnancy, followed by close monitoring given the obstetric complications mentioned above.

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Data availability

The authors declare that the data supporting the findings of this study are available within the article. Additional data are available by the corresponding author upon a reasonable request and subjected to the ethical standards and patients confidentiality.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel

    Yair Shiber, Ron Maymon, Maayan Gal-Kochav, Nadav Kugler, Marina Pekar-Zlotin, Noam Smorgick & Zvi Vaknin

  2. Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yair Shiber, Ron Maymon, Maayan Gal-Kochav, Nadav Kugler, Marina Pekar-Zlotin, Noam Smorgick & Zvi Vaknin

Authors
  1. Yair Shiber
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  2. Ron Maymon
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  3. Maayan Gal-Kochav
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  4. Nadav Kugler
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  5. Marina Pekar-Zlotin
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  6. Noam Smorgick
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  7. Zvi Vaknin
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Contributions

YS: manuscript writing; RM: manuscript editing; MG–K: data collection; NK: data collection; MP-Z: data collection; NS: manuscript editing; ZV: manuscript editing.

Corresponding author

Correspondence to Zvi Vaknin.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board (0281-16-ASF).

Informed consent

Since this is a retrospective study, no informed consent was needed. Patients who were interviewed by the phone gave their informed consent verbally at the beginning of the survey.

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Shiber, Y., Maymon, R., Gal-Kochav, M. et al. Caesarean scar pregnancy: is there a light in the end of the tunnel?. Arch Gynecol Obstet 307, 1057–1064 (2023). https://doi.org/10.1007/s00404-022-06888-4

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  • DOI: https://doi.org/10.1007/s00404-022-06888-4

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