Abstract
BACKGROUND: Cesarean scar pregnancy (CSP) is a high-risk ectopic pregnancy, and the influence of surgical treatments on subsequent fertility and pregnancy outcomes remains poorly understood. This study aimed to investigate the impact of different surgical modalities on these outcomes. METHODS: A retrospective analysis was conducted on 460 CSP patients admitted to the Ninth People's Hospital of Suzhou during the first trimester from January 2015 to December 2023. CSP was categorized into three types based on the implantation site, gestational sac morphology, and the myometrial thickness between the gestational sac and bladder. All patients underwent surgical treatment, which included ultrasound-guided dilation and curettage, hysteroscopic surgery, and combined hysteroscopic and laparoscopic surgery. Clinical information of the patients was systematically collected upon admission, and follow-up data regarding subsequent fertility and pregnancy outcomes were obtained via telephone and verified by medical records. The study outcomes included the incidence of CSP recurrence, secondary infertility, and pregnancy outcomes. RESULTS: Among the 460 eligible CSP patients, 20 were lost to follow-up. Of the remaining 440 patients, 74 attempted pregnancy after CSP treatment (16.8%). Among these 74 patients, 50 achieved live births (67.6%), 12 developed secondary infertility (16.2%), 2 had an ectopic pregnancy (2.7%), 2 experienced a miscarriage (2.7%), and 8 had CSP recurrence (10.8%). The mean interval between previous CSP treatment and subsequent conception was 16.3 ± 10.83 months. The reproductive outcomes following surgical treatment for CSP were not associated with age, gestational age, number of deliveries, miscarriages, cesarean sections, hospital stay, amenorrhea duration at the time of treatment, maximum diameter of the gestational sac, myometrial thickness of the uterine scar, CSP type, surgical method, or use of methotrexate (MTX) during treatment. However, the number of miscarriages was a contributing factor to secondary infertility, and the presence of post-treatment uterine adhesions was the primary risk factor for failure to achieve pregnancy after CSP surgery. CONCLUSION: In the long-term follow-up of women who have undergone CSP treatment, a high success rate in achieving pregnancy and a low recurrence rate were observed. Miscarriages and post-treatment uterine adhesions are risk factors for failure to achieve pregnancy after CSP surgery.