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Standardized algorithm for cesarean scar pregnancy management: single-center outcomes.
Mevlut Bucak1, Kiranpreet Chawla1, Katrina S Mark1
1Department of Obstetrics, Gynecology and Reproductive Science, University of Maryland School of Medicine, Baltimore, MD, USA.
Summary
A standardized algorithm for cesarean scar pregnancy (CSP) management significantly reduced complications. Tailored treatment decisions improved patient outcomes, highlighting the algorithm's clinical utility.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Surgical Management
Background:
- Cesarean scar pregnancy (CSP) poses significant risks.
- Standardized management protocols are crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the clinical utility of a standardized algorithm in managing cesarean scar pregnancy (CSP).
- To compare complication rates between different management strategies guided by the algorithm.
Main Methods:
- Retrospective cohort study of 53 CSP cases (2014-2024).
- Algorithm guided treatment based on fetal cardiac activity, gestational age, myometrial thickness, and patient preference.
- Complications included bladder/ureteral injury, major blood loss, and ICU admission.
Main Results:
- Termination strategies were effective with no complications in pregnancies <14 weeks.
- Expectant management resulted in a 50% complication rate, including bladder damage and major bleeding.
- Expectant management showed a significantly higher complication risk (OR=9.6) compared to termination.
Conclusions:
- The standardized algorithm facilitates tailored, evidence-based treatment decisions for CSP.
- Algorithm-guided management improves clinical outcomes and reduces complication rates in cesarean scar pregnancy.
