The Outcomes of Different Treatment Methods of Cesarean Scar Ectopic Pregnancy in Alavi Hospital, Ardabil

Document Type : Original Article

Authors

1 Resident, Department of Obstetrics and Gynecology, Fellowship of Gynecologic Oncologic, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

2 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

3 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

4 Associate Professor, Department of Community Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.

10.22038/ijogi.2025.81427.6174

Abstract

Introduction: Cesarean scar ectopic pregnancy (CSP) is a potentially life-threatening condition associated with high risk of uterine rupture and severe maternal complications. This study was conducted with aim to evaluate the outcomes of different treatment modalities for CSP.
Methods: This retrospective cross-sectional study was conducted on 120 patients diagnosed with CSP at Alavi Medical Training Center in Ardabil between 2016 and 2021. Patients were treated with one of five approaches: (1) laparotomy, (2) hysteroscopy and curettage, (3) hysteroscopy and curettage following systemic methotrexate, (4) systemic methotrexate alone, or (5) systemic methotrexate combined with potassium hydroxide. Data were analyzed using SPSS software (version 26) and Shapiro-Wilk, ANOVA, independent t-test, Kruskal-Wallis, Mann-Whitney, Chi-square, and Fisher’s exact tests. P<0.05 was considered statistically significant.
Results: History of placenta accreta was observed in 4 patients (3.3%), prior dilatation and curettage in 14 (11.7%), manual removal of placenta in 5 (4.2%), and IVF in 2 (1.7%). Fetal heartbeat was absent in 78 patients (65%). Pre-treatment β-HCG levels were <5000 mIU/mL in 37 patients (30.8%) and >5000 mIU/mL in 83 (69.2%). Significant differences were observed among treatment groups in terms of complete mass resolution, duration of hospitalization, blood transfusion requirement, intraoperative blood loss, and β-HCG normalization speed (p<0.001). However, secondary infection (p=0.15) and hysterectomy rates (p=0.17) were not significantly different.
Conclusion: Combined treatment with systemic methotrexate and hysteroscopy with curettage demonstrated the highest success rate and lowest complications in cesarean scar ectopic pregnancies.

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References

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The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 8
October 2025
Pages 31-40

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