OC08.01: Management and outcomes of non‐viable Caesarean scar pregnancies

To compare the outcomes of first trimester non-viable Caesarean scar pregnancies (CSP) that were treated versus those managed expectantly. A retrospective study of cases with non-viable CSP diagnosed before 14 weeks gestation at a tertiary care institution in New York City between 2010 and 2023. We compared the outcomes of patients undergoing active intervention, including systemic methotrexate (MTX), transcervical balloon catheter placement, and suction aspiration (D&C), to those managed expectantly. The primary outcome was the time-to-sonographic resolution of CSP. Secondary outcomes included complication rates (such as bleeding requiring D&C or hysterectomy), rate of β-hCG decline post-presentation, and time to achieve a negative β-hCG level. 40 patients were diagnosed with non-viable CSP during the study period. Overall, 21 (52.5%) had active management including D&C (n = 4), transcervical double-balloon catheter insertion (n = 5), and systemic MTX (n = 12) as initial treatments. The other 19 (47.5%) were managed expectantly. Demographics and initial sonographic findings were similar between groups. The incidence of bleeding at diagnosis also did not significantly differ between the expectant and intervention groups (26.3% vs 47.6%, p = 0.2). Complete resolution of the CSP was achieved in all patients, with no patient requiring a hysterectomy. After excluding those who had D&C as initial treatment, the interval to sonographic CSP resolution was similar in those managed expectantly compared to those who received medical treatment [10.0 (7.75) versus 12.0 (9.5) weeks respectively, p = 0.5]. There was no difference between the two groups in the rates of bleeding requiring D&C, decrease of bHCG a week after presentation or treatment, and interval to negative bHCG. For patients who are diagnosed with a non-viable CSP in the first trimester, expectant management is a reasonable option without an increased risk of complications or delayed resolution.