(113) Outcomes in symptomatic versus asymptomatic cesarean scar pregnancy

Aim was to examine outcomes in patients who were symptomatic at initial diagnosis of cesarean scar pregnancy (CSP), compared to those who were asymptomatic.

Study Design:

This is a retrospective analysis of all patients who had a CSP at a tertiary referral academic institution from 2010-2013. We excluded patients who elected to continue the pregnancy after counseling. Symptomatic patients (vaginal bleeding, abdominal/pelvic pain) at initial CSP diagnosis, were compared to asymptomatic patients. Primary outcome was complete resolution of CSP not requiring hysterectomy. Secondary outcomes were use of minimally invasive interventions (ultrasound-guided feticide and/or transcervical balloon catheter), time to bHCG and sonographic resolution, need for secondary interventions for persistent bleeding, and other intervention-related complications (including infection, hemorrhage and blood transfusion).

Results:

Of 110 patients diagnosed with CSP during the study period, 15 (13.6%) elected to continue the pregnancy and were excluded. Of the 95 patients included: 33 (34.7%) were symptomatic, 91% with vaginal bleeding and 9% with pelvic pain, whereas 62 (65.3%) were asymptomatic. Symptomatic patients were less likely to have a live CSP compared to asymptomatic (42.4% versus 66.1%, p=0.03) and more likely to be of Hispanic race (66.7% versus 35.5%, p=0.01). Groups were similar for sac location within the scar niche and level of color Doppler. Similarly, there was no difference between the two groups in rate of CSP resolution, complications, use of interventional therapies, and time to bHCG and sonographic resolution.

Conclusion:

Patients who were symptomatic at the time of CSP diagnosis were more likely to have a failed CSP. However, no differences were seen in rate of therapeutic interventions as well as rate and time to complete resolution.