Etiology and efficacy of hysteroscopic management in cesarean scar pregnancy: a clinical study

Abstract

Objective: Cesarean scar pregnancy poses significant risks, including uterine scar rupture and increased postpartum hemorrhage. Effective diagnosis and treatment are critical to improving clinical outcomes. This study aimed to analyze the risk factors for cesarean scar pregnancy and evaluate the efficacy and safety of hysteroscopic diagnosis and treatment, providing a theoretical basis for clinical management.

Methods: A total of 122 patients with cesarean scar pregnancy, diagnosed via vaginal ultrasound, were included in the study group and treated with hysteroscopic surgery. A total of 90 pregnant women with prior cesarean sections and normal intrauterine pregnancies were selected as the control group.

Results: Logistic regression identified significant cesarean scar pregnancy risk factors: the number of uterine operations, the number of cesarean sections, and a time interval of ≤5 years since the last cesarean (p<0.05). After hysteroscopic treatment, the mean operation time, intraoperative bleeding, and surgical failure rate were 22.31±6.26 min, 57.23±9.12 mL, and 8.03%, respectively. Surgical failure was associated with gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels (p<0.05). Hysteroscopy demonstrated superior diagnostic accuracy over ultrasound for type II and type III cesarean scar pregnancy cases (p<0.05).

Conclusion: Hysteroscopic surgery improves treatment outcomes in cesarean scar pregnancy patients. Key risk factors for surgical failure include gestational age, gestational sac position, gestational sac size, diverticulum angle, and blood β-human chorionic gonadotropin levels. Early identification and management of these factors can enhance clinical outcomes and reduce complications.