Abstract
OBJECTIVES: To explore the ultrasound findings, treatment strategies, and reproductive outcomes in patients with recurrent cesarean scar pregnancy (CSP), providing evidence for clinical management. METHODS: We identified 1371 confirmed CSP from 1517 initially screened cases (2012-2022) through blinded image review. From 159 subsequent live births in this cohort, 27 recurrent CSP cases were matched 1:1 with CSP patients having normal subsequent pregnancies. Baseline characteristics and reproductive outcomes were collected via medical records and structured interviews. RESULTS: This study revealed the recurrent CSP group showed significantly higher rates of exogenous implantation pattern (33.3% versus 7.4%, OR = 1.96), rich vascularity on color Doppler (81.5% versus 40.7%, OR = 2.80), and embryonic cardiac activity detection (51.9% versus 18.5%, OR = 1.98) than the normal intrauterine pregnancy group after CSP (p < .05) during initial diagnosis. The most commonly used treatment at our hospital is trans-abdominal ultrasound-guided suction curettage, which effectively controls the condition and preserves fertility. However, during long-term follow-up, some patients still face the risks of recurrence infertility. CONCLUSIONS: Recurrent CSP presents characteristic sonographic features at initial diagnosis, among which an exogenous implantation pattern, rich vascular flow signals, and embryonic cardiac activity serve as relevant and significant indicators. Although transabdominal ultrasound-guided suction curettage is effective in managing the condition and preserving fertility, some patients still face long-term risks of recurrence and infertility.