Clinical characteristics and salvage management of persistent cesarean scar pregnancy

AIM The study was conducted to illustrate the clinical characteristics and treatment outcomes of patients with persistent cesarean scar pregnancy (PCSP). METHODS During a six-year period, 38 cases of PCSP were diagnosed and treated conservatively to preserve fertility. The clinical presentations, imaging findings and treatment outcomes of these patients were reviewed. RESULTS Fourteen out of 38 women (37%) presenting with PCSP suffered heavy vaginal bleeding. Gestational age at diagnosis was 73.1 ± 21.7 days. The maximum diameter of the PCSP mass was 3.6 ± 1.6 cm. The presence of a rich vascular pattern in the area of the PCSP mass was detected by ultrasound in 33/38 (87%) patients. Six patients with a PCSP gestational age of 64.2 ± 6.2 days and a mass diameter of 2.5 ± 0.6 cm were successfully treated with medical treatment alone and 32 patients with a gestational age of 74.8 ± 23.1 days and a mass diameter of 3.8 ± 1.6 cm were successfully treated with surgical or combined treatment. CONCLUSIONS Patients with PCSP are diagnosed at advanced gestational age and are more prone to heavy bleeding. Surgery is the main treatment for PCSP. Medical treatment of PCSP has become an attractive alternative, especially for hemodynamically stable patients with a PCSP mass with a maximum diameter of < 3.5 cm.