Caesarean scar ectopic pregnancy: Evolution from medical to surgical management.

Abstract

Caesarean scar ectopic pregnancy (CSP) is defined as blastocyst implantation occurring in a uterine scar. The incidence of CSP continues to rise with increasing caesarean section rates; prevalence is estimated to be 1:1800 to 1:2226 of all pregnancies. To date, over 30 treatment regimens have been published. The Royal College of Obstetricians and Gynaecologists guidelines (2016) state there is insufficient evidence to support one specific intervention over another. To review outcomes of medical and surgical management of CSP cases at a single tertiary centre over a nine-year period, in order to establish the safest and most effective management approach. An audit was undertaken of patients treated for CSP between January 2009 and March 2017 at King Edward Memorial Hospital, Western Australia. Patient demographic and treatment outcome data were extracted from medical records. Fifty-one patients were identified as having CSP diagnosed during this time period, of which five were excluded due to lack of data, leaving a total of 46 cases. The majority of patients (52%, n=24) elected for initial surgical management, while 41% (n=19) trialled medical management. Seven percent (n=3) opted for conservative management. Success rates of surgical, medical and conservative management were 100%, 53% and 0% respectively (P<0.001). Medical management was associated with prolonged follow-up; there was no difference in complication rates between surgical and medical managements. In this audit, surgical management was the most effective way to manage CSP. There was no significant difference in complication rates between the two groups.