Management of Myomectomy Scar Pregnancy: A Scoping Review

Abstract

Background: Ectopic pregnancy (EP) is defined as the implantation of an embryo outside the uterine cavity, which can lead to high morbidity and mortality if not diagnosed and treated promptly. A rare form of EP is myomectomy scar pregnancy (MSP), where the embryo implants in a scar from a prior myomectomy. Due to its rarity, MSP presents unique diagnostic and therapeutic challenges. This scoping review aims to map the existing literature on MSP to better understand the diagnostic strategies, management options, and clinical outcomes associated with this condition, and to identify gaps in current research. Methods: We conducted a scoping review by searching databases such as PubMed, Scopus, Web of Science, and MEDLINE for studies published between 2003 and 2023. Keywords used in combination included "myomectomy scar pregnancy", "scar pregnancy", "leiomyoma", "uterine myomectomy", "PAS disorders", "placenta previa", and "placenta accreta". Studies were screened for relevance and eligibility by two independent reviewers. Data were extracted from case reports, retrospective studies, and reviews discussing MSP. Results: From an initial set of 111 studies, 28 papers met the inclusion criteria, comprising 4 retrospective studies and 24 case reports. A total of 44 cases of MSP were analyzed. The majority of diagnoses were made through ultrasound, with magnetic resonance imaging (MRI) used in more complex cases. Surgical interventions, primarily cesarean sections and myometrial repairs, were the most common treatments, while medical therapy with methotrexate was less frequently applied. Conclusions: This scoping review highlights the challenges of diagnosing and managing MSP due to its rarity. Although surgical management remains the primary approach, there is a lack of consensus on the optimal treatment for different clinical scenarios. Further research is needed to establish standardized diagnostic and therapeutic protocols for MSP and to evaluate the long-term outcomes of affected patients.

Keywords: PAS disorders; leiomyoma; myomectomy; scar pregnancy.

Figure 1

PRISMA flow diagram.

Figure 2

Complications reported in the included studies. (SM: Spontaneous Miscarriage; UR: Uterine rupture; BP: bleeding during pregnancy; PAS: placenta accreta spectrum; UP: uncomplicated pregnancy). NB “Uncomplicated pregnancy” refers to cases in which no maternal or fetal complications were explicitly reported in the original publication. Subclinical or minor complications may not have been assessed or documented.