Management Strategies for First-Trimester Cesarean Scar Pregnancy Revealed in Study

by Ella

Researchers have identified effective management approaches for first-trimester cesarean scar pregnancies, including suction evacuation, balloon treatment, and surgical excision, as published in the American Journal of Obstetrics and Gynecology.


Led by Dr. Andrea Kaelin Agten, MD, CCT, a consultant in maternal-fetal medicine at Liverpool Women’s Hospital NHS Foundation Trust, U.K., and Corniche Hospital in Abu Dhabi, United Arab Emirates, the team established an international registry for cesarean scar pregnancies. The registry, spanning 31 centers across 19 countries, collected ultrasound and clinical data from 460 women (mean age: 35 years) who underwent active medical or surgical treatment before 12 weeks gestation between August 2018 and February 2023.


Of the cases, 281 were viable pregnancies, and 179 were failing cesarean scar pregnancies. The study found that 58.7% of women opted for surgical management, 26.7% underwent medical management, 10% chose balloon management, and 4.6% pursued less common treatment options.


Key Findings:

Suction evacuation emerged as highly effective, successfully managing 91.5% of cases.


Systemic methotrexate, conversely, showed the lowest effectiveness, with 59.4% of women requiring additional treatment.

Surgical treatments achieved a success rate of 91.5%, with a 9.3% complication rate.

The most frequently used surgical treatment was suction evacuation, utilized in 43.4% of live and 55.3% of failing cesarean scar pregnancies.

Overall, suction evacuation, surgical excision, and balloon catheter treatment were the most effective first-trimester cesarean scar pregnancy treatments, with success rates of 91.5%, 91.8%, and 91.3%, respectively. Complication rates for these treatments were 8.5%, 13.5%, and 8.7%, respectively.

Dr. Kaelin Agten highlighted the significance of early diagnosis and treatment, emphasizing that the effectiveness of all treatment options decreases with advancing gestational age. The study, considered the largest multicenter dataset on cesarean scar pregnancies, provides valuable insights into safe and effective management options for women facing this condition. Ongoing research is exploring the management of cesarean scar pregnancy in the second trimester, according to Dr. Kaelin Agten.


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