Photo Credit: Taras Grebinets

The following is a summary of “Systematic evaluation of the efficacy of treatments for cesarean scar pregnancy,” published in the July 2024 issue of Obstetrics and Gynecology by Sun et al.

Cesarean scar pregnancy (CSP) is a critical type of ectopic pregnancy that can lead to severe complications, such as significant hemorrhage, the need for hysterectomy, and other life-threatening risks. Despite the availability of two classification methods—vial (types Ia and IIa) and Chinese Expert’s Consensus (types I^b, II^b, and III^b)—these frameworks fall short in effectively guiding treatment decisions for CSP. 

This study aimed to systematically evaluate the efficacy of various treatments for CSP within the clinical practice.

Researchers included about 906 patients diagnosed with CSP from January 2013 to December 2018. Researchers utilized chi-squared tests and logistic regression analyses to compare clinical characteristics. Additionally, they calculated the median and IQR for relevant metrics. The study also assessed whether the preoperative administration of methotrexate (MTX) could enhance surgical outcomes and examined the characteristics of patients with misdiagnosed CSP.

Significant differences were observed in gestational age, gestational sac dimensions (diameter, width, and area), remnant myometrial thickness, vaginal bleeding, and preoperative hemoglobin levels (P< 0.001). However, the incidence of residual tissue did not show a significant difference (P= 0.053). Other factors, including intraoperative blood loss, hemoglobin decline, postoperative hemoglobin levels, total hospital stay, duration of postoperative hospitalization, transfusion requirements, and catheter drain duration, varied significantly (P< 0.001). For type I^a and I^b CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound guidance. Conversely, for type II^a and III^b CSP, 29.9% and 62.7% of patients, respectively, underwent laparotomy. No significant differences were found between the MTX and non-MTX groups regarding surgical methods, residual tissue, and reoperation rates (P= 0.20). However, the MTX group experienced more liver damage, longer hospital stays, and increased pain perception. Notably, 14% of the patients were initially misdiagnosed with an intrauterine pregnancy, with the misdiagnosis rate being higher in patients with type II^a CSP compared to patients with type Ia CSP (P< 0.001).

For patients with type I CSP, D&E under ultrasound or hysteroscopy is recommended. For type III^b CSP, surgical resection is advisable. However, selecting the appropriate treatment method for type II^a or II^b CSP remains challenging, necessitating further research and clinical refinement. This study underscores the need for precise diagnostic and therapeutic approaches tailored to the specific CSP type to optimize patient outcomes.

Source: rbej.biomedcentral.com/articles/10.1186/s12958-024-01256-0