To describe treatment and outcomes of patients with confirmed cesarean scar ectopic pregnancy (CSEP) at a tertiary referral center.
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.
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.
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.
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Accepted: March 13, 2023
Received in revised form: March 4, 2023
Received: December 6, 2022
Publication stageIn Press Accepted Manuscript
☆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.
© 2023 Elsevier Inc. All rights reserved.