Factors affecting the prognosis of cesarean scar pregnancy-An analysis of 118 cases

To evaluate the efficacy of different treatment methods for cesarean scar pregnancy (CSP) as the primary objective, and to identify the prognostic factors associated with treatment failure as the secondary objective.

A retrospective analysis was conducted on 118 patients diagnosed with CSP in our gynecology department. Data on general demographics, clinical characteristics, diagnostic approaches, treatment modalities, and therapeutic outcomes were collected and evaluated using transvaginal or transabdominal ultrasonography, gynecological examination, and biochemical assays. The efficacy of initial treatment strategies was compared, and subsequent treatments were analyzed in cases of initial failure. Furthermore, the associations between various clinical factors and treatment failure were investigated.

In the comparison of initial treatment modalities for CSP, pharmacological therapy and simple curettage were associated with significantly lower success rates in complete lesion removal (P < 0.01). Among patients who experienced initial treatment failure, methotrexate (MTX) demonstrated a higher success rate in managing residual CSP lesions (P < 0.01). Logistic regression analysis identified the presence of fetal cardiac activity and abundant peritrophoblastic blood flow signals as significant predictors of failure in first-line CSP treatment (P < 0.01).

Surgical excision of uterine scar lesions, laparoscopic or ultrasound-guided curettage, and interventional embolization combined with perfusion chemotherapy, especially when integrated with adjunctive therapies, represent safe and effective approaches for the management of CSP.