The role of Hysteroscopy in the management of caesarean scar pregnancy: a systematic review and meta-analysis.

OBJECTIVE

To evaluate the effectiveness, safety, and clinical applicability of hysteroscopy (HSC) in the management of caesarean scar pregnancy (CSP) and to assess its potential role as a first-line treatment.

DATA SOURCES: We conducted a search in MEDLINE (via Ovid), Scopus and Web of Science from inception through May 2, 2025.

STUDY ELIGIBILITY CRITERIA: The protocol is registered in PROSPERO (CRD420251004342). Articles were eligible if: (1) CSP patients were managed with operative HSC; (2) HSC was the primary therapeutic approach and not an adjuvant; (3) the treatment regimen, adverse effects, outcomes and success rate were reported; (4) observational or interventional studies.

STUDY APPRAISAL AND SYNTHESIS

METHODS

This systematic review followed the PRISMA 2020 guidelines. Two authors independently screened titles and abstracts using predefined inclusion and exclusion criteria. We performed multilevel and random-effects meta-analyses of proportions to pool success and complication rates. Univariable meta-regression was performed to explore pontencial sources of heterogeneity.

RESULTS

The review included 28 articles with 4258 CSP patients, of whom 2587 were treated with HSC. The overall success rate was 94% with a complication rate of 4%. Success rates were comparable for HSC alone (95%), methotrexate and HSC (91%), and uterine artery embolization plus HSC (90%). The complication rate was 4%, 5% and 0%, respectively.

CONCLUSIONS

HSC is a safe, effective fertility-preserving option in hemodynamically stable patients in the management of CSP, with a low risk of complications, including hysterectomy. This procedure can be used alone or in combination with other treatments.