Recurrent Cesarean scar pregnancy: case series and literature review

OBJECTIVES: To determine the rate of recurrent Cesarean scar pregnancy (CSP) in our clinical practices and to evaluate whether the mode of treatment of a CSP is associated with the risk of recurrent CSP, as well as to review the published literature on recurrent CSP.METHODS: We performed a retrospective search of our six obstetrical and gynecologic departmental ultrasound databases for all CSPs and recurrent CSPs between 2010 and 2019. We extracted various data, including numbers of CSPs with follow-up, numbers attempting and numbers achieving pregnancy following treatment of the CSP and numbers of recurrent CSPs, as well as details of the treatment of the original CSP. After analyzing the clinical data, we evaluated whether the mode of treatment terminating the previous CSP was associated with the risk of recurrent CSP. We also performed a PubMed search for: 'recurrent Cesarean scar pregnancy' and 'recurrent Cesarean scar ectopic pregnancy'. Articles were reviewed for year of publication and extraction and analysis of the same data as those obtained from our departmental databases.RESULTS: Our database search identified 252 cases of CSP. The overall rate of clinical follow-up ranged between 71.4% and 100%, according to treatment site (mean, 90.9%). Among these, 105 were followed by another pregnancy after treatment of the previous CSP. Of these, 36 (34.3%) pregnancies were recurrent CSP, with 27 women having a single recurrence and three women having multiple recurrences, one with two, one with three and one with four. We did not find any particular single or combination treatment mode terminating the previous CSP to be associated with recurrent CSP. The literature search identified 17 articles that yielded sufficient information for us to evaluate their reported prevalence of recurrent CSP. They reported 1743 primary diagnoses of CSP, and 944 had reliable follow-up. There were data for 489 cases in which a woman attempted to conceive again, and on 327 pregnancies achieved, after treatment of a previous CSP. Of these, 67 (20.5%) were recurrent CSP.CONCLUSION: On the basis of our pooled clinical data and review of the literature, recurrent CSP is apparently more common than was previously assumed based upon mostly single case reports or series with few cases. This should be borne in mind when counseling patients undergoing treatment for CSP regarding their risk of recurrence. We found no obvious causal relationship or association between the type of treatment for the previous CSP and recurrence of CSP. Patients pregnant after treatment for a CSP should be encouraged to have an early (5-7-week) first-trimester transvaginal scan to determine the location of the gestation. This article is protected by copyright. All rights reserved.