Abstract
Placental accreta (PLA) has increased and is identified as a significant risk factor for PLA. Clinical approaches for treating cesarean scar pregnancy (CSP) varied, there is still controversy over whether CSP patients can continue pregnancy. This study aimed to use ultrasound monitoring to explore the connection between CSP and PLA. We retrospectively analyzed 24 patients diagnosed with CSP at the obstetrics and gynecology department of our hospital from 2015 to 2022. Patients were categorized into low-risk (CSPI and CSPII) and high-risk (CSPIII) groups based on ultrasound findings, and continuous ultrasound assessment was performed to gauge the severity of PLA. Pregnancy outcomes of both the groups were then compiled. Among the 24 patients, 22 were in the low-risk group, with 13 of them suspected of having placental increta or percreta prior to surgery. Ultimately, surgery confirmed 1 case without accreta, 2 cases of PLA, 7 cases of placental increta, and 3 cases of placental percreta. The ultrasound diagnostic sensitivity was 77% (10/13). The remaining 9 patients, initially suspected to have only PLA or none, were all confirmed during surgery, aligning with preoperative assessments. Ultrasound diagnostic specificity was 100%. Within the low-risk group, 20 patients had live births and 20 retained their uterus. In the high-risk group, 2 patients were preoperatively diagnosed with placenta percreta, both confirmed during surgery. Results indicated 1 termination at 16 weeks and another at 33 weeks with a live fetus, with both cases requiring uterine removal. The study suggests that invasive placenta might be an outcome of CSP, and ultrasound-based classification of CSP could forecast pregnancy outcomes, offering clinical direction for CSP patients opting to continue pregnancy.