A Possible Role of Clinical Factors in Choosing the Best Treatment Modality in Cesarean Scar Pregnancy

Background/Objectives: Cesarean scar pregnancy (CSP) refers to a pregnancy implanted on or within a scar from a previous cesarean birth. This study aims to evaluate the treatment strategies for CSP conducted at a single center and analyze the predictive markers of a single procedure without complications. Methods: A retrospective study was performed on CSP patients who received treatment at Korea University Ansan Hospital from November 2002 to December 2022. The clinical characteristics of CSP and the occurrence of complications based on treatment methods were investigated. Results: A total of 128 patients were included in the study. Among them, 84 patients (65.6%) underwent dilatation and curettage (D&C) only, 12 patients (9.4%) received a combination of methotrexate and D&C, 21 received D&C with Foley catheter ballooning (15.7%), and 11 patients (9%) underwent invasive procedures such as uterine artery embolization, hysterectomy, and open resection. As gestational age increased, the likelihood of opting for invasive procedures (aOR = 3.52, 95% CI 1.74-10.14, p = 0.003) also increased. A total of 84 patients (65.6%) were successfully treated with D&C without transfusion, and it was found that early gestational age and sonographic hypervascularity played a significant role. Conclusions: Early gestational age, younger maternal age, and sonographic hypervascularity were independently associated with favorable treatment without adjuvant therapy and transfusion. Therefore, for a safe and bloodless approach to treatment in cases of CSP, it is advisable to promptly diagnose this condition as early as possible.