Standardized algorithm for cesarean scar pregnancy management: single-center outcomes

To evaluate the clinical utility of a standardized algorithm in the management of cesarean scar pregnancy (CSP) by assessing and comparing complication rates.

This retrospective cohort study included 53 CSP cases treated between January 2014 and September 2024. A standardized algorithm was utilized to guide treatment decisions based on factors such as fetal cardiac activity, gestational age, myometrial thickness, and patient preferences for uterine preservation. Data collected included maternal demographics, clinical characteristics, treatment modalities, and complications (bladder injury, ureteral injury, estimated blood loss ≥3000, >4 units of packed red blood cells, admission to the intensive care unit, presence of at least one of these was evaluated as a complication). Statistical comparisons of complication rates were performed using Fisher's Exact Test, and odds ratios (ORs) were calculated.

Of the 53 cases, 42 (79.2%) had fetal cardiac activity, while 11 (20.8%) did not. Termination strategies, including suction curettage and methotrexate combined with suction curettage, were highly effective in pregnancies under 14 weeks, with no complications reported. Three complications occurred after hysterotomy or gravid hysterectomy for pregnancies beyond 14 weeks. Expectant treatment had the greatest complication rate, with 50% of patients experiencing poor outcomes such as bladder damage (30%), major bleeding (≥3000 mL; 30%), and ICU admission (10%). 80% of expectant management patients had a placenta accreta spectrum. Compared to the termination group, expectant management was associated with a significantly higher complication risk (OR = 9.6, 95% CI = 1.7-53.8, p = 0.009).

The study demonstrates that our standardized algorithm improves CSP outcomes by providing tailored, timely, and evidence-based treatment decisions.