Long-term gynecologic, reproductive, and ultrasound outcomes after hysteroscopic resection vs dilation and evacuation for cesarean scar pregnancy: a secondary analysis of a randomized clinical trial.
Brunella Zizolfi, Gabriele Saccone, Enrica Mastantuoni et al.
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In 30 seconds
This secondary analysis followed women from a randomized trial comparing hysteroscopic resection with ultrasound-guided dilation and evacuation, both preceded by systemic methotrexate, for cesarean scar pregnancy with embryonic cardiac activity. Of 51 eligible women, 26 (51%) participated in follow-up at a median of 4.59 years. Dysmenorrhea was less frequent after hysteroscopic resection (6.3% vs 50.0%; relative risk, 0.13 [95% confidence interval, 0.02-0.92]). Other gynecologic and reproductive outcomes showed no clear differences; ultrasound niche frequency was similar, although niche depth and residual myometrial thickness differed.
Key findings
- Dysmenorrhea occurred in 6.3% after hysteroscopic resection and 50.0% after dilation and evacuation (relative risk, 0.13 [95% confidence interval, 0.02-0.92]).
- Among women attempting conception, 7 of 8 in the hysteroscopic group and 1 in the dilation and evacuation group achieved a subsequent pregnancy; the latter was a recurrent cesarean scar pregnancy.
- Uterine niche frequency was similar (63.6% vs 66.7%; relative risk, 0.95 [95% confidence interval, 0.38-2.39]), while niche depth was greater and residual myometrial thickness thinner after hysteroscopic resection.
Why it matters
Long-term outcomes after treatment of cesarean scar pregnancy may include symptoms, subsequent pregnancy, and changes in the cesarean scar. These findings provide follow-up information beyond immediate treatment success, while the limited participation and small ultrasound and conception subgroups mean that apparent differences should be interpreted cautiously.
What to keep in mind
Only 26 of 51 eligible women participated in long-term follow-up, and 14 underwent ultrasound assessment. Conception outcomes were based on 9 women who attempted pregnancy, limiting precision and generalizability.