Are the Risk Factors for Developing Type 1 and Type 2 Cesarean Scar Pregnancy Different?

Cesarean scar pregnancy (CSP) is a life-threatening complication of pregnancy. Early termination of pregnancy is recommended because of the potential risks of uterine rupture if the pregnancy continues. CSP is clinically divided into type 1 and type 2, based on the site of embryo implantation and grow direction of the gestational sac. The clinical risk and treatment options may vary between these subtypes. Identifying the differences and potential factors impacting the development of each type could contribute to improved clinical management.

This retrospective study included 143 women with type 1 CSP and 200 women with type 2 CSP women, diagnosed between January 2020 and July 2023. The primary objective was to analyze the differences in clinical characteristics between the 2 CSP subtypes.

Body mass index, the number of previous CSPs, elective abortions, gravidity, and parity were not significantly different between the 2 subtypes. Similarly, the interval between the last cesarean section and the current CSP was not associated with developing the 2 subtypes. However, women with more than 3 prior cesarean sections had an increased risk of developing type 1 CSP. In contrast, vaginal bleeding before diagnosis was more frequently associated with type 2 CSP.

Our study with a large sample size found that despite type 2 CSP involving deeper myometrial invasion, the 2 subtypes share many clinical characteristics. Moreover, the clinical risk factors for distinguishing between type 1 and type 2 CSP are limited. Future research to identify predictors for CSP classification is required.