Reproductive Outcomes Following High-Intensity Focused Ultrasound Treatment for Cesarean Scar Pregnancy

Area of Science:

• Reproductive Medicine
• Minimally Invasive Surgery
• Gynecologic Oncology

Background:

• Cesarean scar pregnancy (CSP) presents a rare but severe risk of uterine rupture and hemorrhage.
• Optimizing fertility-preserving treatments for CSP is a significant clinical challenge.

Purpose of the Study:

• To evaluate the reproductive outcomes and risk factors in CSP patients undergoing conservative surgery with High-Intensity Focused Ultrasound (HIFU).

Main Methods:

• A retrospective cohort study compared 337 CSP patients divided into HIFU (n=210) and non-HIFU (n=127) groups.
• Multivariate logistic regression analyzed predictors of re-pregnancy and recurrent CSP (RCSP).

Main Results:

• The HIFU group showed significantly higher re-pregnancy rates (61.9%) compared to the non-HIFU group (38.6%).
• HIFU treatment (OR=2.728) and longer intervals since last C-section (OR=5.497) predicted higher re-pregnancy.
• RCSP incidence was lower in the HIFU group (21.5% vs. 42.9%), with HIFU reducing RCSP odds by 67.7% (OR=0.323).
• Thicker scars (OR=0.663/mm) and fewer prior C-sections were protective against RCSP.

Conclusions:

• Conservative surgery with HIFU enhances re-pregnancy rates and reduces RCSP risk in CSP patients.
• Factors like younger age, longer C-section intervals, and fewer prior surgeries positively impact re-pregnancy.
• Thicker scar tissue and fewer cesarean sections are associated with reduced RCSP risk.