Ultrasound Guided Suction Evacuation for Cesarean Scar Ectopic Pregnancy: Effectiveness, Safety, Hemostasis Strategies, and Comparative Outcomes in a Systematic Review

Background: Cesarean scar pregnancy (CSP) carries substantial hemorrhagic risk and threatens future fertility. Ultrasound guided suction evacuation (UGSE), often with immediate balloon tamponade, is used as a uterus conserving option. In this study we aimed to synthesize original studies evaluating the effectiveness and safety of UGSE for CSP. Methods: We performed a PRISMA aligned review of original studies of UGSE for CSP. Eligible designs included retrospective or prospective cohorts and case series that reported procedural success, hemorrhage control measures, transfusion, major complications, β-hCG resolution, and short-term recovery. Meta-analysis was not attempted because of heterogeneity. Results: Ten original studies (from 2014 to 2025) met inclusion criteria. Most enrolled hemodynamically stable first trimester CSP and performed continuous ultrasound guidance with flexible cannulas; many used routine Foley catheter tamponade after evacuation. In studies, procedural success was high and severe complications uncommon. Series that standardized balloon tamponade reported particularly low rates of additional interventions and short hospital stays. Some comparative cohorts suggested similar or improved primary success for UGSE versus hysteroscopic assisted evacuation, with low transfusion needs overall. Where reported, β-hCG normalized within weeks. Conclusions: In appropriately selected early CSP managed by experienced teams, UGSE, especially with immediate balloon tamponade, achieves high success with favorable safety and recovery profiles. Structured peri operative protocols (readiness for hemostasis and adjuncts) appear integral to outcomes.