Reproductive outcomes in women with prior cesarean scar pregnancies over six years

To explore the impact of two surgical methods, ultrasound-guided vacuum aspiration and laparoscopic scar resection with repair on the reproductive outcomes of patients with caesarean scar pregnancy. We systematically selected 562 women who had undergone surgical treatment for caesarean scar pregnancies at a tertiary hospital in China between May 2017 and July 2022. After 6 years of follow-up, the reproductive outcomes of 100 women who desired future pregnancies were ultimately tracked. We retrospectively analysed the clinical data and follow-up records of these women to explore the impact of the two surgical methods on their reproductive outcomes. Among those 100 patients, 43(43%) live births, 19(19%) miscarriages, 15(15%) RCSP, and 38 (38%) cases of secondary infertility. Comparison of the clinical data between the ultrasound-guided vacuum aspiration and laparoscopic scar resection with repair groups showed that patients in the latter had longer hospital stays, higher gestational age at treatment, greater maximum GS diameter, and lower BMI (P < 0.05). Women with thicker myometrial layers at the caesarean scar site were more likely to have live births in subsequent pregnancies (P = 0.044; HR 1.207; 95% CI 1.001-1.909). Older women were at higher risk of miscarriage and recurrent caesarean scar pregnancies (P = 0.028; HR 1.868; 95% CI 1.765-1.985).The reproductive outcomes of women with caesarean scar pregnancies after surgical treatment are optimistic.The reproductive outcomes were not dependent on the type of surgical methods used, either ultrasound-guided vacuum aspiration or laparoscopic scar resection with repair for the treatment of caesarean scar pregnancy. Advancing maternal age in subsequent pregnancies is a risk factor for adverse reproductive outcomes and warrants attention.