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Cesarean Scar Pregnancy, Incidence, and Recurrence: Five-Year Experience at a Single Tertiary Care Referral Center

Grechukhina, Olga, MD; Deshmukh, Uma, MD; Fan, Linda, MD; Kohari, Katherine, MD; Abdel-Razeq, Sonya, MD; Bahtiyar, Mert Ozan, MD; Sfakianaki, Anna K., MD

doi: 10.1097/AOG.0000000000002940
Contents: Ectopic Pregnancy: Original Research

OBJECTIVE: To describe the treatment and subsequent pregnancy outcomes in patients with cesarean scar pregnancies at a single institution over 5 years.

METHODS: This is a case series of all cesarean scar pregnancies diagnosed from May 2013 to March 2018 at Yale-New Haven Hospital. Data were collected on each patient using electronic medical record review and included patient demographics; medical, surgical, and obstetric history; pregnancy characteristics; treatment modalities used; response to therapy; complications; and subsequent pregnancy outcomes.

RESULTS: Thirty cases of cesarean scar pregnancies were diagnosed in 26 patients, including one recurrence in one patient and three recurrences in another. Forty-six percent of cesarean scar pregnancies were in Hispanic women. The median number of prior cesarean deliveries was two. Mean gestational age at the time of diagnosis was 46 days (SD±10). Fetal cardiac activity was detected in 18 cases. Three patients initially were erroneously diagnosed with a viable intrauterine pregnancy and failed medical termination. Others opted for termination through systemic methotrexate alone (n=4), systemic and local methotrexate (n=12), systemic and local methotrexate with potassium chloride injected into the gestational sac (n=3), potassium chloride injection with laparotomy and wedge resection (n=1), methotrexate with bilateral uterine artery embolization (n=2), or intrauterine balloon (n=4). Five patients who underwent expectant management or methotrexate therapy had retained products of conception and required hysteroscopy and curettage. One patient opted for hysterectomy after failed curettage. After complete resolution of cesarean scar pregnancies, there were 10 subsequent spontaneous conceptions in eight patients, including four recurrent cesarean scar pregnancies, four term pregnancies, and one spontaneous abortion. One viable normally located pregnancy is ongoing.

CONCLUSION: There is a wide array of treatment modalities available for cesarean scar pregnancies. Women with a cesarean scar pregnancy are at risk for its recurrence in the future, although normal pregnancy after a cesarean scar pregnancy is also possible. Safe outcomes depend on timely diagnosis and multidisciplinary care by skilled clinicians.

Timely diagnosis, individualized approach in treatment choice, thorough counseling, and close follow-up are required to achieve optimal immediate and long-term outcomes for patients with cesarean scar pregnancies.

Department of Obstetrics, Gynecology and Reproductive Sciences, Yale-New Haven Hospital, New Haven, Connecticut.

Corresponding author: Olga Grechukhina, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063; email: olga.grechukhina@yale.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented as a poster at the American College of Obstetricians and Gynecologists' Annual Clinical and Scientific Meeting, May 6–9, 2017, San Diego, CA.

Each author has indicated that he or she has met the journal's requirements for authorship.

Peer review history is available online at http://links.lww.com/AOG/B167.

Received June 20, 2018

Received in revised form August 06, 2018

Accepted August 09, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.