EP21.13: Caesarean scar pregnancy: an observational cohort study

Retrospective observational study conducted at a tertiary centre in Spain. All cases of CSP diagnosed between 2020 and 2023 were included and were defined and classificated according to the Delphi consensus criteria. Data were collected including maternal characteristics, US findings, β-hCG titers, type of management, and outcomes. Pros and cons regarding treatment and complications were discussed with all patients. Six cases of CSP were identified. Median GA at diagnosis was 5+5 weeks (4-7+1). 83.3% (5/6) of patients were symptomatic: 33% (2/6) presented with vaginal bleeding and 50% (3/6) with bleeding and abdominal pain. 83% was a β-hCG titer >1500 IU. Transvaginal US was the primary imaging approach in all cases. 85% of the CSPs had a positive heartbeat (median Crown–rump length 6 mm). According to the Delphi consensus, 33% were type 1, 33% type 2, and 33% type 3. Residual myometrial thickness was ≥3mm in 50% of cases and <3mm in the remaining 50%. Expectant management was decided in 33% (2/6): one case of non-viable CSP who had an uncomplicated miscarriage and one case of a viable pregnancy who is now 18 weeks, remaining asymptomatic with no PAS suspected yet. Medical treatment (systemic methotrexate) was indicated in 66% but 2 on them (50%) required a second approach (intragestational KCl-injection) due to insufficient β-hCG decrease and/or fetal heartbeat still present. The overall success rate of medical approaches was 100% with no complications. Surgical therapies were not necessary. CSP presents clinical complexities due to the lack of standardised management guidelines. Clinical and US findings must be carefully considered in patient assessment. Expectant management should be only considered in non-viable CSP or type 1 when patient assumes the risk of a possible complication.