(114) Subsequent pregnancy outcomes in patients with a history of cesarean scar pregnancy

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Submitting Author and Presenting Author(s)

Alexa L. Cohen, MD

University of Miami Health System
Miami, Florida, United States

Coauthor(s)

ES

Eliane Shinder, MD

Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
LD

Leeann Dar

Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
CP

Chloe Porigow

Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
FE

Fatima Estrada Trejo, MD

Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
OR

Ohad Rotenberg, MD

Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
Pe'er Dar, MD

Professor and Director, Division of Fetal Medicine
Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States
Georgios Doulaveris, MD

Assistant Professor
Montefiore Medical Center, Albert Einstein College of Medicine
New York, New York, United States

Objective:

We aimed to report on the reproductive outcomes of patients with a history of cesarean scar pregnancy (CSP) who retained their fertility.

Study Design:

A retrospective review of CSP cases treated at a tertiary academic center from 2010 to 2023. Cases treated with hysterectomy or electing pregnancy continuation leading to placenta accreta spectrum (PAS) and hysterectomy were excluded. Reproductive follow-up data was recorded for patients who retained their fertility. The primary outcome evaluated was the recurrence of CSP or PAS. Secondary outcomes included rates of live birth, postpartum hemorrhage (defined as >1L blood loss), preterm delivery, and uterine rupture.

Results:

Out of 111 CSP cases identified, 92 qualified for the study. Among these, 37 patients (40.2%) had 54 subsequent pregnancies. The average maternal age was 32.9 ± 0.8 years. The average inter-pregnancy interval following the CSP was 16.6 ± 2.4 months. Elective pregnancy termination occurred in 5.5% of cases. The recurrence rate for CSP and PAS combined was 5.8%. Early pregnancy loss occurred in 18 (35.3%) subsequent pregnancies, with an overall live birth rate of 64.7%. Spontaneous preterm birth occurred in 9.6% of cases, and 29.0% experienced postpartum hemorrhage during repeat cesarean delivery. One patient (3.1%) suffered a uterine rupture at 28 weeks’ gestation.

Conclusion:

Patients with a history of CSP have a 5.8% risk for recurrent CSP or PAS, which underscores the need for early ultrasound assessment in these cases. The live birth rate in pregnancies after CSP is 64.7%.