Risk factors of persistent cesarean scar pregnancy after dilation and curettage: a matched case-control study

To investigate the risk factors of persistent cesarean scar pregnancy (PCSP) after dilation and curettage (D&C).

A retrospective, age-matched case-control study including 45 cases of PCSP patients after D&C was conducted between January 2013 and April 2018. For each case, 4 women who had been diagnosed with CSP and had the same age and same hospitalization period as the case group but no residual CSP tissue after D&C were selected as the controls (Control group, n = 180). Conditional logistic regression analysis was used to assess the risk factors of PCSP after D&C.

After conditional logistic regression, the 3 factors associated with PCSP after D&C were maximum diameter of CSP mass (or gestational sac) ≥4.5 cm (adjusted odds ratio [aOR] 6.51, 95% CI 1.39-30.47), myometrial thickness at the implantation site <2 mm (aOR 3.58, 95% CI 1.37-9.38) and a ≤66.42% decrease rate in β-hCG levels on the first day after D&C (aOR 18.58, 95% CI 5.80-59.57). ROC analysis showed that the indicator [(hCG₀-hCG₁)/hCG₀*100%] has a good predictive value for PCSP, and the area under the curve (AUC) is 0.745; when the cut-off value is equal to 66.42%, the indicator has the best predictive value, with a sensitivity of 82.2% and a specificity of 67.7%.

For these high-risk patients with PCSP, choosing individualized treatment options and proper management could reduce the incidence of PCSP.