Management of Cesarean Scar Ectopic Pregnancies at an Academic Referral Center [A82

Abstract

INTRODUCTION: Cesarean scar ectopic pregnancies (CS-EP) represent less than 1% of ectopic pregnancies and are associated with significant morbidity when undiagnosed. Currently, no standard of care exists for optimal management. METHODS: We reviewed our de-identified family planning clinical database for patients seen by our subspecialty service for CS-EP from 7/2017-6/2021 as a quality assurance project. We extracted referral date, final diagnosis, management, and outcome information. RESULTS: Of 47 patients referred for suspected CS-EPs, 16 (34%) had a confirmed diagnosis with eight less than and eight greater than 50 days gestation (range 39-58 days). Most (n=40[85%]) referrals occurred in the last 2 years of the 4-year study period. We treated all eight patients less than 50 days primarily with suction aspiration under ultrasound guidance with no complications and estimated blood loss (EBL) of 17±11mL. The eight patients greater than 50 days included six managed with primary aspiration, of which four were uncomplicated, one required intrauterine Foley balloon (EBL 200 mL), and one had uterine perforation and exploratory laparotomy (EBL 250 mL). Two patients primarily received systemic methotrexate with aspiration after significant hCG decline, one uncomplicated and one requiring intrauterine Foley balloon (EBL 250mL). One patient (57 days) had attempted intrauterine double-catheter balloon for primary treatment with immediate hemorrhage requiring uterine artery embolization followed by an uncomplicated suction aspiration. CONCLUSION: Patients with confirmed CS-EPs at less than 50 days gestation can be primarily treated with suction aspiration with low risk for significant adverse outcomes. CS-EPs of greater than 50 days gestation are more likely to have complicated outcomes.