Reproductive Outcomes After Previous Cesarean Scar Pregnancy:the Follow Up And Analysis

Objective:To investigate the reproductive and pregnancy outcomes of women after previous Cesarean Scar Pregnancy.Methods:From April 2006 to April 2016,a total of 327 patients with CSP received surgical evacuation treatment by means of dilation and suction evacuation,Uterine Artery Embolization and local resection of the ectopic gestational mass.A telephone follow-up was conducted after CSP treatment to collect the details on subsequent fertility outcomes in these women,which included intervals between the previous CSP and subsequent pregnancy,maternal and neonatal outcomes of these subsequent pregnancies and mode of delivery.The follow-up was during June 2016 to september 2016.Results:Forty-seven patients were lost to follow-up.The previous medical records of the remaining 280 women were reviewed.Seventy-four women wished to give birth again.However,34(50%,37/74)of them stopped the attempts to get pregnant because they were afraid of recurrent CSP,placenta accreta,placenta previa and the high risk of uterine rupture during the subsequent pregnancy.The other 37 women spontaneously attempted to get pregnant again,among whom 21(56.7%,21/37)succeeded with the birth of 21 healthy babies(4 by spontaneous labor and 17 by cesarean section).A total of 54 women conceived again,either in plan or by chance.Nine women(16.7%,9/54)experiencing recurrent CSP.Conclusion:Most women were able to conceive following CSPs.Reproductive outcomes included normal intrauterine term pregnancy,miscarriage,recurrent CSP,and infertility.Placenta accreta,which could be misdiagnosed antenatally,was a serious complication in subsequent pregnancies.Diverticulum or defect in the lower uterine segment could happen after CSP.Repair of the uterine defect,following a CSP neither guaranteed the healing of the scar,nor the ability to ensure a safe pregnancy outcome.Appropriate counseling to women desiring fertility with a history of CSP is essential and once they conceive early referral to tertiary centers for follow up is pertinent.Although we make great effort to improve the sample size,decrease the rate of lost to follow-up,but in the end we only collected the date from 280 patients with CSP.Even though our result did not necessarily represent the true recurrence rate,our study provided some evidence about the likelihood of fertility and recurrence risk for future pregnancies after previous CSP.