MATERNAL OUTCOMES FOLLOWING CONSERVATIVE AND SURGICAL MANAGEMENT OF CESAREAN SCAR PREGNANCY: A RETROSPECTIVE

Abstract

Objective: To compare the effectiveness of various treatment modalities in a cesarean scar pregnancy, in terms of the success rate of treatment and maternal parameters among women treated at a tertiary care hospital. Methodology: The present Retrospective Analytical Comparative Study was carried out in Nishtar Hospital Multan after getting approval from the Institutional Review Board / Ethics Committee. The medical records of women with the diagnosis of cesarean scar pregnancy (CSP) from 3 to 6 months were examined. Treatment was based on the clinical judgment and institutional procedures of the attending consultant, including medical management with methotrexate, ultrasound-guided suction evacuation, hysteroscopic resection, laparoscopic resection or open surgical management as clinically indicated. The main outcome was treatment success, which was the complete resolution of CSP without requiring further treatment and the preservation of the uterus. Results: Among 100 women with cesarean scar pregnancy, treatment success was significantly higher with surgical management than conservative management (98% vs. 80%, p=0.003), with fewer repeat interventions (2% vs. 18%, p=0.007). Surgical management was also associated with lower blood loss (115 ± 42 vs. 180 ± 70 mL), shorter hospital stay (2.1 ± 0.7 vs. 3.8 ± 1.4 days), fewer blood transfusions (4% vs. 16%), and faster β hCG normalization (28 ± 8 vs. 42 ± 13 days). Overall complications were significantly lower in the surgical group (8% vs. 22%, p=0.046). Multivariable analysis identified surgical management as an independent predictor of treatment success (adjusted OR 5.84, 95% CI 1.31–26.10, p=0.021). Conclusion: The surgical treatment of cesarean scar pregnancy was more successful, had less maternal morbidity, less blood loss, shorter hospital stays and fewer surgical procedures in comparison with conservative pregnancy treatment. A timely diagnosis, with transvaginal ultrasonography, and the choice of treatment is key to maximize maternal health with the maintenance of uterine integrity and future fertility.