Caesarean Scar Pregnancy in the UK: A National Cohort Study

BJOG. 2018 Dec;125(13):1663-1670. doi: 10.1111/1471-0528.15255. Epub 2018 Jun 5.

Abstract

Objective: To estimate the incidence of caesarean scar pregnancy (CSP) and to describe the management outcomes associated with this condition.

Design: A national cohort study using the UK Early Pregnancy Surveillance Service (UKEPSS).

Setting: 86 participating Early Pregnancy Units.

Population: All women diagnosed in the participating units with CSP between November 2013 and January 2015.

Methods: Cohort study of women identified through the UKEPSS monthly mailing system.

Main outcome measures: Incidence, clinical outcomes and complications.

Results: 102 cases of CSP were reported, with an estimated incidence of 1.5 per 10 000 (95% CI 1.1-1.9) maternities. Full outcome data were available for 92 women. Management was expectant in 21/92 (23%), medical in 15/92 (16%) and surgical in 56/92 (61%). The success rates of expectant, medical and surgical management were 43% (9/21), 46% (7/15) and 96% (54/56), respectively. The complication rates were 15/21 (71%) with expectant, 9/15 (60%) with medical and 20/56 (36%) with surgical management. Discharge from care (median number of days) was 82 (range 37-174) with expectant, 21 (range 10-31) with medical and 11 (range 4-49) with surgical management.

Conclusions: Surgical management appears to be associated with a high success rate, low complication rate and short post-treatment follow up.

Tweetable abstract: Surgery for CSP appears to be successful, with low complication rates and short post-treatment follow up.

Keywords: Caesarean; caesarean scar pregnancy; cohort study; ectopic; placenta accreta.

MeSH terms

  • Abortifacient Agents, Nonsteroidal / therapeutic use
  • Cesarean Section / adverse effects*
  • Cicatrix / complications*
  • Cohort Studies
  • Dilatation and Curettage / adverse effects
  • Female
  • Humans
  • Incidence
  • Live Birth
  • Methotrexate / therapeutic use
  • Pregnancy
  • Pregnancy, Ectopic / diagnosis
  • Pregnancy, Ectopic / epidemiology*
  • Pregnancy, Ectopic / etiology
  • Pregnancy, Ectopic / therapy*
  • Treatment Outcome
  • United Kingdom / epidemiology
  • Watchful Waiting

Substances

  • Abortifacient Agents, Nonsteroidal
  • Methotrexate