Outcomes of nonsurgical versus surgical treatment of cesarean scar pregnancies in the first trimester

To compare outcomes of nonsurgical versus surgical treatment of Cesarean scar pregnancies (CSP) in the first trimester and identify optimal treatment methods for CSP.

Retrospective cohort study of all women diagnosed and treated with CSP in the first trimester at a single tertiary care center from 2000-2012. Main outcome measures were need for additional treatments, hemorrhage, or emergent hysterectomy. Future pregnancy outcomes were considered secondarily.

Twenty-three cases of CSP treated in the first trimester were confirmed including 12 treated surgically and 11 treated nonsurgically. Of the nonsurgical patients, none treated with a combination of intrasac potassium chloride (KCl) and systemic methotrexate (MTX) required further treatment versus 5/8 (62%) of those treated with a single agent (p = 0.18). One patient who was treated with intrasac KCl alone experienced hemorrhage. Of the nine patients treated with suction dilation and curettage (D&C), two (22%) required additional intervention, but none experienced major complications. Nonsurgical therapy had a higher rate of needing further intervention (45%) than surgical therapy (17%) (p = 0.19). There was one recurrent CSP in 11 subsequent deliveries with no uterine ruptures or hysterectomies.

We have described nonsurgical and surgical treatments of first trimester CSP with a low rate of major complications and no emergent hysterectomies. Of the nonsurgical therapies, single-agent treatment with either systemic MTX or intrasac KCl was associated with high rates of needing additional treatment and should be avoided. Our method of ultrasound-guided suction D&C resulted in no major hemorrhage and is a reasonable surgical treatment option.