Outcomes After Surgical Versus Medical Management of Cesarean Scar Ectopic Pregnancy [ID 1728]

INTRODUCTION: Optimal management of cesarean scar ectopic pregnancy (CSEP) remains controversial. We compared complication rates between medical and surgical management. METHODS: We completed a single-center retrospective chart review from January 2008 to February 2024. We identified charts using CSEP-related terms and confirmed diagnosis on ultrasound review. We collected demographics, management variables, and clinical outcomes. Medical management included local or systemic methotrexate or both, local potassium chloride, or misoprostol with or without mifepristone. Surgical management included suction dilation and curettage (D&C), laparoscopic resection, or hysterectomy. Our primary outcome was a composite of the following complications: estimated blood loss greater than 1,000 cc, transfusion, superficial or intra-abdominal infection, cystotomy, unplanned hysterectomy, uterine artery embolization, reoperation, stay greater than two nights, intensive care transfer, or readmission. We compared outcomes using chi-squared. RESULTS: We identified 66 CSEPs. Planned management included 25 (38%) medical and 41 (62%) surgical. Median gestational age at treatment was 7.3 weeks (interquartile range [IQR], 6.2, 9.0) in medical and 8.1 weeks (IQR, 6.6, 9.5) in surgical groups. We found higher complication rates for medical management compared to surgical management (13/25 [52%] versus 11/41 [27%]; RR 1.9; 95% CI, 1.0–3.6). Suction D&C was associated with a lower complication rate than other surgical management methods (7/34 [20%] versus 7/11 [64%]; RR 3.1; 95% CI, 1.4–6.9). Initial misdiagnosis of CSEP was associated with higher complication rates (10/22 [45%] versus 8/40 [20%]; RR 2.0; 95% CI, 1.1–3.8). CONCLUSIONS/IMPLICATIONS: We found lower complication rates among CSEPs managed surgically versus medically, and lower complication rates with suction than other surgical methods.