Quantitative imaging in medicine and surgery · 2026
Management and outcomes of heterotopic cesarean scar pregnancies: a single-center retrospective case series.
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Li Cong, Chen Wenyi, Xu Hong, Luo Hong
Аннотация
BACKGROUND: Heterotopic pregnancy (HP) is defined as the coexistence of an intrauterine gestation and an ectopic pregnancy, with heterotopic cesarean scar pregnancy (HCSP) being a rare and high-risk subtype. HCSP occurs when the ectopic embryo implants in the niche of a previous cesarean section (CS) scar, carrying a high risk of life-threatening complications such as uterine rupture and massive bleeding. Currently, there are no universally accepted clinical management guidelines for HCSP. This study aimed to describe the clinical management strategies and outcomes of patients with confirmed HCSP at West China Second University Hospital over a 10-year period, in which all cesarean scar pregnancies (CSPs) occurred with a niche.
METHODS: A retrospective analysis was conducted on 15 patients diagnosed with HCSP in the first trimester at West China Second University Hospital over a 10-year period, where all CSP cases occurred with a niche. Clinical data were extracted, including ultrasound examination results, clinical management approaches (expectant management or surgical treatment), outcome measures [gestational age (GA) at delivery, intrapartum blood loss, neonatal birth weight (NBW), hospital stay], delivery complications, and post-treatment reproductive outcomes.
RESULTS: A total of 15 cases were included in this study. The GA at delivery of the fetuses of the five patients with expectant management was 31+4, 34, 36, 37+1, and 37+6 gestational weeks (GWs), and the intrapartum blood loss was 4,700, 800, 3,700, 1,000, and 1,200 mL, respectively. NBW was 1,760, 2,140, 2,700, 2,325, and 2,890 g, respectively. Of the five patients who underwent expectant management, three patients had dangerous placenta previa. Morbidly adherent placenta (MAP) occurred in all five cases. A total of 10 patients were treated primarily with dilation and curettage (D&C) under ultrasound guidance after uterine artery embolization (UAE) or hysteroscopic surgery. No products of conception were retained in any of these cases, and there were no complications. The median estimated blood loss was 40 (range, 10-100) mL. The median hospital stay was 4 (range, 3-8) days.
CONCLUSIONS: For patients with HCSP, expectant management can be successful, especially in cases without fetal heartbeat, but it is associated with a high incidence of delivery complications. Ultrasound-guided D&C after UAE may be a safe and suitable surgical management option for HCSP.
METHODS: A retrospective analysis was conducted on 15 patients diagnosed with HCSP in the first trimester at West China Second University Hospital over a 10-year period, where all CSP cases occurred with a niche. Clinical data were extracted, including ultrasound examination results, clinical management approaches (expectant management or surgical treatment), outcome measures [gestational age (GA) at delivery, intrapartum blood loss, neonatal birth weight (NBW), hospital stay], delivery complications, and post-treatment reproductive outcomes.
RESULTS: A total of 15 cases were included in this study. The GA at delivery of the fetuses of the five patients with expectant management was 31+4, 34, 36, 37+1, and 37+6 gestational weeks (GWs), and the intrapartum blood loss was 4,700, 800, 3,700, 1,000, and 1,200 mL, respectively. NBW was 1,760, 2,140, 2,700, 2,325, and 2,890 g, respectively. Of the five patients who underwent expectant management, three patients had dangerous placenta previa. Morbidly adherent placenta (MAP) occurred in all five cases. A total of 10 patients were treated primarily with dilation and curettage (D&C) under ultrasound guidance after uterine artery embolization (UAE) or hysteroscopic surgery. No products of conception were retained in any of these cases, and there were no complications. The median estimated blood loss was 40 (range, 10-100) mL. The median hospital stay was 4 (range, 3-8) days.
CONCLUSIONS: For patients with HCSP, expectant management can be successful, especially in cases without fetal heartbeat, but it is associated with a high incidence of delivery complications. Ultrasound-guided D&C after UAE may be a safe and suitable surgical management option for HCSP.