Subsequent Fertility in Women Treated for Caesarean Scar Pregnancy With Hysteroscopy: A 5-Year Follow-Up Descriptive Study in a Tertiary Hospital.

Xinyi Sun,Min Zhao,Qi Chen,Yang Liu,Yunhui Tang,Hongying Yu

doi:10.3389/fendo.2021.659647

Abstract

ObjectiveThe outcomes of subsequent pregnancies and fertility in women with a history of caesarean scar pregnancy have not been well described. In this study, we followed up 149 women with a history of caesarean scar pregnancy and analysed the effect on their fertility.Methods149 women with a history of caesarean scar pregnancy were followed up for five years. Of them, 53 women had unprotected sexual intercourse attempting to become pregnant again. Data including clinical parameters and treatment options at the time of diagnosis of caesarean scar pregnancy, and the outcomes in subsequent pregnancy were collected. In addition, a questionnaire about the menstrual cycle after treatment was voluntarily completed by these women.ResultsOf the 53 women, 46 (84%) women had a subsequent pregnancy, while seven (14%) women did not. There was no association between the clinical parameters in previous caesarean scar pregnancy or treatment and future fertility. From the questionnaire, there was no difference seen in the length of the menstrual cycle and menses between the two groups. However, a higher number of women with light menstrual bleeding were seen in women without a subsequent pregnancy (67%), compared with women who did (28%). In addition, six women (13%) who had a subsequent pregnancy experienced foetus death in the first trimester.ConclusionWe reported that 14% of women with a history of cesarean scar pregnancy did not have a subsequent pregnancy, after unprotected sexual intercourse for more than two years. Light menstrual bleeding after treatment may be associated with this adverse effect. Our findings need to be further investigated with large sample size.

Highlights

The incidence of caesarean scar pregnancy is relatively low, with an estimated 0.04% to 0.05% of pregnancies worldwide [1]
There were 96 (64%) women had protected sexual intercourse to avoid further pregnancy after an initial treatment of caesarean scar pregnancy, as they were fearful of another caesarean scar pregnancy
While seven (14%) women did not have a subsequent pregnancy after at least 2 years of treatment of the caesarean scar pregnancy (Figure 1)

Summary

Introduction

The incidence of caesarean scar pregnancy is relatively low, with an estimated 0.04% to 0.05% of pregnancies worldwide [1]. Five treatment options (transvaginal resection; laparoscopy; uterine artery embolization combined with dilatation, curettage, and hysteroscopy; uterine artery embolization in combination with dilatation and curettage; and hysteroscopy) are recommended [2,3,4], to date there is still no agreement on the most optimal management of caesarean scar pregnancy. This is because of the limited number of clinical studies (including clinical trials) with a large enough sample size [5, 6] and this results in the majority of studies on caesarean scar pregnancy being reported in the literature as case series. Hysteroscopy resection is the most common option for cesarean scar pregnancy treatment in China, including in our hospital, this is a less commonly used treatment option, especially in the United States [2, 7]

Methods

Results

Discussion

Conclusion