Unified management of cervical and cesarean scar pregnancies: A low-risk approach

To compare cervical pregnancy (CP) and cesarean scar pregnancy (CSP) in terms of risk factors, clinical presentation, and treatment outcomes, and to evaluate the feasibility of similar management strategies.

This retrospective study included all CP and CSP cases diagnosed and treated between 2014 and 2022 in a tertiary gynecology department. Data were collected from electronic medical records and included demographics, medical history, clinical presentation, diagnosis, treatment, and follow up.

Among 899 ectopic pregnancies, 10 were CP and 32 were CSP. Compared with CP, CSP patients had higher gravidity (mean 4.2 ± 2.2), parity (mean 2.1 ± 1.1), and number of previous cesarean deliveries (mean 1.8 ± 1.1). No significant differences were observed in maternal age, smoking status, or use of assisted reproductive techniques. CP patients had higher human chorionic gonadotropin (hCG) levels at diagnosis (6247.51 ± 5738.7 IU/L vs. 23394.93 ± 25091.3 IU/L, P = 0.041). Both groups presented at similar gestational ages, though bleeding was more common in CP. CP treatments included surveillance (20%), methotrexate (20%), dilatation & evacuation (D&E) (20%), or a combination (40%). CSP treatments included methotrexate (9.4%), D&E (46.9%), or a combination (40.6%). No CSP cases were managed conservatively. Maternal morbidity was not reported. Three patients required blood transfusions, but no intensive care unit admissions or readmissions occurred.

Although CP and CSP differ in certain clinical and demographic characteristics, similar treatment approaches may be feasible. Initial treatment with methotrexate followed by D&E appears promising, but further data are needed to confirm safety and effectiveness. Prospective studies are warranted to guide standardized protocols.