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Expectant management of viable cesarean scar pregnancies: a systematic review

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Abstract

Objective

Cesarean scar pregnancy (CSP) is a potentially life-threatening disease that has been steadily increasing in prevalence. Pregnancy termination is usually recommended given the risk of life-threatening complications. In some cases, patients refuse to terminate viable CSPs, even after counseling. Recent studies report that, even with a high burden of possible complications and maternal morbidity, many CSPs progress to live, close to term births. The aim of this study is to further demonstrate the natural history of viable cesarean scar pregnancies.

Methods

We conducted a systematic review of original studies reporting cases of expectant management of CSPs with positive fetal heartbeats.

Results

After selection, 28 studies were included in the review, with a total of 398 cases of CSP, 136 managed expectantly and 117 with positive fetal heartbeat managed expectantly. This study confirmed that the majority of patients experience live births, as 78% of patients selected for expectant management experienced live births at or close to term, with 79% developing morbidly adherent placenta, 55% requiring hysterectomy, and 40% having severe bleeding.

Discussion

The optimal management protocol for CSP is still to be defined and more studies are needed to further elucidate this rare but rising disease. Our study provides information on the natural history of untreated CSPs and suggests that termination may not be the only option offered to the patient.

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Data availability

The data that support this systematic review and meta-analysis are available from the corresponding author, upon reasonable request.

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Funding

No funds, grants, or other support was received. The authors have no financial or proprietary interests in any material discussed in this article.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Universidade Federal Do Paraná, Curitiba, Paraná, Brazil

    Paula Vieira de Mello & Rafael Frederico Bruns

  2. Obstetrics and Gynecology Residency Program, Hospital de Clínicas do Paraná, Curitiba, Paraná, Brazil

    Cynthia Fontoura Klas & Larissa Raso Hammes

Authors
  1. Paula Vieira de Mello
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  2. Rafael Frederico Bruns
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Contributions

PVM: project development, data collection, data analysis, manuscript writing. RFB: project development, manuscript editing. CFK: data collection, manuscript editing. LRH: data collection, manuscript editing. All authors contributed to this study. RFB envisioned this review, material preparation, data collection and analysis were performed by PVM, assisted by LRH and CFK. The first manuscript was written by PVM and all authors commented, edited and approved the final manuscript.

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Correspondence to Paula Vieira de Mello.

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Vieira de Mello, P., Bruns, R.F., Fontoura Klas, C. et al. Expectant management of viable cesarean scar pregnancies: a systematic review. Arch Gynecol Obstet 308, 701–707 (2023). https://doi.org/10.1007/s00404-022-06835-3

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  • DOI: https://doi.org/10.1007/s00404-022-06835-3

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