Abstract
Objective
To describe treatment and outcomes of patients with confirmed cesarean scar ectopic
pregnancy (CSEP) at a tertiary referral center.
Study Design
We reviewed a de-identified family planning clinical database for patients seen by
our subspecialty service for CSEP from January 2017 through December 2021 in this
case series. We extracted referral information, final diagnosis, management, and outcome
measures including estimated blood loss (EBL), secondary procedures and treatment
complications.
Results
Of 57 cases referred for suspected CSEPs, 23 (40%) had confirmed diagnoses; one additional
case was diagnosed during clinic evaluation for early pregnancy loss. Most (n=50 [88%])
referrals occurred in the last 2 years of the 5-year study period. Of 24 confirmed
CSEP cases, 8 were pregnancy losses at the time of diagnosis. Fourteen cases were
≤50 days gestation or gestational size (7 [50%] pregnancy losses) and 10 >50 days
gestation (range 39-66 days). We treated all 14 patients ≤50 days primarily with suction
aspiration under ultrasound guidance in an operating room with no complications and
EBL of 14±10 mL. Of the ten patients >50 days (maximum 66 days), 7 were managed with
primary aspiration of which 5 were uncomplicated. We treated one patient (57 days)
had primary intrauterine double-catheter balloon with immediate hemorrhage requiring
uterine artery embolization followed by an uncomplicated suction aspiration.
Conclusion
Patients with confirmed CSEPs at 50 days or less gestation or gestational size can
likely be primarily treated with suction aspiration with low risk for significant
adverse outcomes. Treatment success and complications are directly related to gestational
age at treatment.
Keywords
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Article info
Publication history
Accepted:
March 13,
2023
Received in revised form:
March 4,
2023
Received:
December 6,
2022
Publication stage
In Press Accepted ManuscriptFootnotes
☆Presented in part as a poster at the American College of Obstetricians and Gynecologists’ Annual Clinical and Scientific Meeting, May 6-8, 2022, San Diego, CA.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
