First-trimester cesarean scar pregnancy manageable with some surgical, medical treatments
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Key takeaways:
- Suction evacuation was a very effective treatment for first-trimester cesarean scar pregnancy.
- Surgical excision and balloon treatment were also effective in managing first-trimester cesarean scar pregnancies.
Cesarean scar pregnancy in the first trimester can be effectively managed through suction evacuation, balloon treatment or surgical excision, researchers reported in the American Journal of Obstetrics and Gynecology.
Andrea Kaelin Agten, MD, CCT, consultant in maternal-fetal medicine at Liverpool Women’s Hospital NHS Foundation Trust, U.K., and Corniche Hospital in Abu Dhabi, United Arab Emirates, and colleagues created an international registry of cesarean scar pregnancies to assess ultrasound findings, disease behavior and cesarean scar pregnancy management. The registry collects anonymous ultrasound and clinical data of individual patients with cesarean scar pregnancy from 31 participating centers in 19 countries. From August 2018 to February 2023, researchers recorded 460 women (mean age, 35 years) with cesarean scar pregnancy who received active medical or surgical treatment before 12 weeks gestation.
Overall, 281 cases were live and 179 were failing cesarean scar pregnancies. More than half (58.7%) of women utilized surgical management, 26.7% underwent medical management, 10% underwent balloon management and 4.6% underwent less frequently used treatment options for cesarean scar pregnancies.
Suction evacuation was a very effective treatment, with 91.5% of women having successful management, whereas systemic methotrexate was the least effective, with 59.4% of women not requiring additional treatment.
Surgical treatment for cesarean scar pregnancies was successful for 91.5% of women, with a 9.3% complication rate. The most frequently utilized surgical treatment was suction evacuation in 43.4% of live and 55.3% of failing cesarean scar pregnancies. The most effective treatments for first-trimester cesarean scar pregnancy were suction evaluation, surgical excision and balloon catheter treatment, with success rates of 91.5%, 91.8% and 91.3%, respectively, and complication rates of 8.5%, 13.5% and 8.7%, respectively.
According to Kaelin Agten, researchers are currently studying the management of cesarean scar pregnancy in the second trimester.
“This is the largest multicenter dataset comparing different treatment options for cesarean scar pregnancies. It shows that women have the option of different treatment methods that are both safe and effective,” Kaelin Agten told Healio. “The effectiveness of all treatment options decreases with advancing gestational age, so cesarean scar pregnancy should be treated as early as possible after confirmation of the diagnosis.”
For more information:
Andrea Kaelin Agten, MD, CCT, can be reached at a.kaelin@gmail.com.