Recurrent Cesarean scar pregnancy: case series and literature review

Abstract

Objectives To determine the rate of recurrent Cesarean scar pregnancy (CSP) in our clinical practices and to evaluate whether the mode of treatment of a CSP is associated with the risk of recurrent CSP, as well as to review the published literature on recurrent CSP. Methods We performed a retrospective search of our six obstetric and gynecological departmental ultrasound databases for all CSPs and recurrent CSPs between 2010 and 2019. We extracted various data, including number of CSPs with follow‐up, number of cases attempting and number achieving pregnancy following treatment of CSP and number of recurrent CSPs, as well as details of the treatment of the original CSP. After analyzing the clinical data, we evaluated whether the mode of treatment terminating the previous CSP was associated with the risk of recurrent CSP. We also performed a PubMed search for: ‘recurrent Cesarean scar pregnancy’ and ‘recurrent Cesarean scar ectopic pregnancy’. Articles were reviewed for year of publication, and extraction and analysis of the same data as those obtained from our departmental databases were performed. Results Our database search identified 252 cases of CSP. The overall rate of clinical follow‐up ranged between 71.4% and 100%, according to treatment site (mean, 90.9%). Among these, 105 women had another pregnancy after treatment of the previous CSP. Of these, 36 (34.3%) pregnancies were recurrent CSP, with 27 women having a single recurrence and three women having multiple recurrences, one with two, one with three and one with four. We did not find any particular single or combination treatment mode terminating the previous CSP to be associated with recurrent CSP. The literature search identified 17 articles that yielded sufficient information for us to evaluate their reported prevalence of recurrent CSP. These reported 1743 primary diagnoses of CSP, of which 944 had reliable follow‐up. Data were available for 489 cases that attempted to conceive again after treatment of a previous CSP, and on the 327 pregnancies achieved. Of these, 67 (20.5%) were recurrent CSP. Conclusions On the basis of our pooled clinical data and review of the literature, recurrent CSP is apparently more common than was previously assumed based upon mostly single‐case reports or series with few cases. This should be borne in mind when counseling patients undergoing treatment for CSP regarding their risk of recurrence. We found no obvious causal relationship or association between the type of treatment of the previous CSP and recurrence of CSP. Patients who become pregnant after treatment of a CSP should be encouraged to have an early (5–7‐week) first‐trimester transvaginal scan to determine the location of the gestation. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

“In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience

“…A caesarean scar pregnancy (CSP) is a subtype of ectopic pregnancy where the embryo is implanted in the muscle or fibrous tissue of the scar resulting from a previous caesarean section (C-section) [ 1 ]. This specific localization was described for the first time in 1978, and the recent literature indicates that CSP is more common than previously assumed, based upon mostly case reports and case series [ 2 , 3 ].…”

The value of transvaginal sonography in predicting salvage use of laparoscopy for cesarean scar pregnancy

“…Sonography is a noninvasive, convenient, effective approach and is an important determinant for whether CSP patients will require the use of laparoscopy. Timor-Tritsch IE encourage patients to have an early first-trimester transvaginal scan to determine the location of the gestation [18]. Sonography can be beneficial in determining the need for transfer of the patient to a tertiary hospital, and the first-line doctors there decide whether do the preoperative preparation.…”

Cervical Ectopic and Cesarean Scar Pregnancies: Navigating the Differential of an Abnormal Lower Uterine Pregnancy

“…The rate of cesarean scar pregnancy recurrence was 34.3%, with 27 women having a single recurrence, 3 women having multiple recurrences'1 with 2 and 1 with 4 recurrences. There were no significant differences in rates between the type of treatment of previous cesarean scar pregnancy and risk of recurrence 48. Thus, women who are considering attempting to conceive after cesarean scar pregnancy should be advised of the significant risk of recurrence, estimated to range from 15% to 30%, along with potential associated morbidity.…”