Treatment in cesarean scar pregnancy: a retrospective cohort study

This study aimed to explore the clinical efficacy of surgical treatments for cesarean scar pregnancy (CSP) and to analyze factors associated with CSP subtypes.

From 2013 to 2022, 265 patients diagnosed with CSP at the Gynecology Department of the Second Affiliated Hospital of Anhui Medical University were retrospectively enrolled and classified into Type 1 (n = 198) and Type 2 (n = 67). Clinical characteristics and outcomes were comparatively analyzed between the groups.

In the Type 1 group, 167 patients (84.3%) underwent hysteroscopic surgery, while 31 (15.7%) received laparoscopic intervention. In contrast, within the Type 2 group, 12 patients (17.9%) were treated with hysteroscopy, whereas 55 (82.1%) underwent laparoscopy. Multivariate logistic regression analysis identified that age ≥ 30 years (OR = 0.385, 95% CI 0.206-0.722), total number of pregnancies ≥ 4 (OR = 1.738, 95% CI [0.815-3.706]), and an interval of ≥ 5 years since the last cesarean section (OR = 2.044, 95% CI [1.133-3.685]) were independently associated with CSP subtype (Type 2 vs. Type 1). A total of 265 patients underwent either hysteroscopic (n = 179) or laparoscopic (n = 86) surgery. Separate regression models for surgical outcomes identified CSP Type 2 and the laparoscopic approach as significant predictors for both prolonged operative time and increased intraoperative blood loss.

In this cohort, treatment selection was individualized based on clinical evaluation. The surgical approach chosen in practice was strongly aligned with the CSP subtype, with both hysteroscopy and laparoscopy being demonstrated as feasible.