Early diagnosis and effective treatment of endogenous and exogenous cesarean scar pregnancies: A retrospective case series

Abstract

Objective: To evaluate the diagnostic accuracy of and the efficacy, safety, and cost effectiveness of treatment for endogenous and exogenous cesarean scar pregnancies (CSP). CSPs result from the amniotic sac implanting into the CS; endogenous CSPs grow toward the uterine cavity, while exogenous CSPs infiltrate the uterine myometrium. Methods: Sixty nine (69) endogenous and exogenous CSP patients were retrospectively reviewed. The former group included two subgroups: dilation and curettage (D&C) alone, and combined D&C with uterine artery embolization (UAE). Treatment type, complications, and treatment costs were recorded. Means and standard deviations were calculated for all variables for each group and sub-group. Independent t-tests were conducted to compare all variables between the groups and subgroups. Results: Sixty nine (69) patients were reviewed: 47 endogenous and 22 exogenous CSPs. 41 endogenous CSPs underwent ultrasound-guided D&C. Two had complications and underwent surgical resections. The 6 remaining endogenous CSPs successfully underwent UAE and hysteroscopy-guided D&C. Patients receiving the combined treatment did have significantly higher expenses (P<0.05). All 22 exogenous CSPs successfully underwent surgical resections. The exogenous CSPs had significantly higher hospitalization expenses than the endogenous CSPs (P<0.05). Conclusion: It is safe and cost effective to use ultrasound-guided D&C for endogenous CSPs and surgical resections for exogenous CSPs.