Outcomes of nonsurgical versus surgical treatment of cesarean scar pregnancies in the first trimester.

PURPOSE: To compare outcomes of nonsurgical versus surgical treatment of Cesarean scar pregnancies (CSP) in the first trimester and identify optimal treatment methods for CSP.

METHODS: Retrospective cohort study of all women diagnosed and treated with CSP in the first trimester at a single tertiary care center from 2000-2012. Main outcome measures were need for additional treatments, hemorrhage, or emergent hysterectomy. Future pregnancy outcomes were considered secondarily.

RESULTS: Twenty-three cases of CSP treated in the first trimester were confirmed including 12 treated surgically and 11 treated nonsurgically. Of the nonsurgical patients, none treated with a combination of intrasac potassium chloride (KCl) and systemic methotrexate (MTX) required further treatment versus 5/8 (62%) of those treated with a single agent (p = 0.18). One patient who was treated with intrasac KCl alone experienced hemorrhage. Of the nine patients treated with suction dilation and curettage (D&C), two (22%) required additional intervention, but none experienced major complications. Nonsurgical therapy had a higher rate of needing further intervention (45%) than surgical therapy (17%) (p = 0.19). There was one recurrent CSP in 11 subsequent deliveries with no uterine ruptures or hysterectomies.

CONCLUSIONS: We have described nonsurgical and surgical treatments of first trimester CSP with a low rate of major complications and no emergent hysterectomies. Of the nonsurgical therapies, single-agent treatment with either systemic MTX or intrasac KCl was associated with high rates of needing additional treatment and should be avoided. Our method of ultrasound-guided suction D&C resulted in no major hemorrhage and is a reasonable surgical treatment option.