Textbook outcomes in patients with a cesarean scar pregnancy: A comprehensive analysis from a single Eastern center...

Quality medical care is crucial in evaluating clinical results. This study assessed the value of medical quality control using the comprehensive indicator "textbook outcome" (TO) in patients with a cesarean scar pregnancy (CSP). This study included 140 patients from a CSP cohort from April 01, 2022 to May 31, 2024. TO was characterized by the total removal of the gestational sac, lack of intraoperative complications, absence of severe postoperative complications, freedom from re-interventions, no unplanned admissions to the intensive care unit, postoperative hospital stay of ≤7 days, zero postoperative mortalities within 30 days post-surgery, and no readmission within 30 days post-surgery. Logistic regression was used to analyze factors contributing to non-TO. Overall, 119 (85.0%) achieved a TO. Significant differences were observed between the TO and non-TO groups in terms of the number of days with abdominal pain, number of days with vaginal bleeding, number of days without menstruation, history of cesarean section in a primary healthcare hospital, time from previous cesarean section to CSP, gestational sac size, and CSP classification (all P < .05). Most patients in the TO group received high-intensity focused ultrasound (HIFU) combined with hysteroscopy (53.8%), resulting in lower average intraoperative blood loss, length of hospital stay, and hospitalization cost compared to the non-TO group (all P < .05). The postoperative pain score in the TO group was lower (P = .002), and the time required for β-hCG levels to return to normal in the TO group was shorter than in the non-TO group (P = .025). Multivariate logistic analysis revealed that history of cesarean section at a primary hospital, CSP-III classification, and intraoperative blood loss exceeding 30 mL were independent risk factors for a non-TO (all P < .05), whereas HIFU combined with hysteroscopy was an independent protective factor against non-TO (P = .020). Our findings highlight that patients with a history of cesarean section managed in primary healthcare hospitals, CSP-III classification, and intraoperative blood loss exceeding 30 mL are independent risk factors for adverse outcomes in CSP management. Notably, the combination of HIFU and hysteroscopy effectively facilitates the achievement of TO in these high-risk patients, offering a minimally invasive therapeutic option. These results provide actionable clinical guidance for prioritizing monitoring and intervention in at-risk groups.