Vaginal bleeding with or without abdominal pain may be first symptoms of Cesarean scar pregnancy, suggests study

Cesarean scar pregnancy (CSP) is a distinct form of ectopic pregnancy that was initially identified in 1978. CSP occurs as a significant late complication of cesarean section (CS), characterized by the presence of a gestational sac that becomes implanted in the scar tissue resulting from a prior CS. Recent research paper examined the clinical characteristics and risk factors associated with cesarean scar pregnancy (CSP), a rare but life-threatening type of ectopic pregnancy. The study was a retrospective case-control study that included 291 CSP patients and 317 full-term pregnant women with a history of cesarean section (control group). The key findings of the study are: 1. The only symptoms suggestive of CSP were vaginal bleeding with or without abdominal pain, as there are no unique early clinical features. 2. Possible independent risk factors for CSP include maternal age over 35 years, gravidity over 3 (especially over 5), more than 2 induced abortions (especially over 5), an interval less than 5 years (especially less than 2 years) between the current pregnancy and last cesarean section, history of cesarean section performed at a rural hospital, history of induced abortions after cesarean section, and retroposition of the uterus. 3. The study suggests that CSP may be the result of a combination of multiple factors associated with cesarean section, and there may be similarities between the risk factors for incomplete healing of cesarean scars and the risk factors for CSP. Further research is needed to evaluate the relationship between cesarean scar defects and CSP.

Conclusion

The authors conclude that early diagnosis, termination, and clearance should be the treatment principles for CSP, and that future research is needed to better understand the relationship between cesarean scar defects and this rare ectopic pregnancy.

Key Points

1. The only symptoms suggestive of cesarean scar pregnancy (CSP) were vaginal bleeding with or without abdominal pain, as there are no unique early clinical features.

2. Possible independent risk factors for CSP include: - Maternal age over 35 years - Gravidity over 3 (especially over 5) - More than 2 induced abortions (especially over 5) - Interval less than 5 years (especially less than 2 years) between the current pregnancy and last cesarean section - History of cesarean section performed at a rural hospital - History of induced abortions after cesarean section - Retroposition of the uterus

3. The study suggests that CSP may be the result of a combination of multiple factors associated with cesarean section, and there may be similarities between the risk factors for incomplete healing of cesarean scars and the risk factors for CSP.

4. Further research is needed to evaluate the relationship between cesarean scar defects and CSP.

5. Early diagnosis, termination, and clearance should be the treatment principles for CSP.

6. Future research is needed to better understand the relationship between cesarean scar defects and this rare ectopic pregnancy.

Reference -

Xiaoping Zhou et al. (2020). Identifying Possible Risk Factors For Cesarean Scar Pregnancy Based On A Retrospective Study Of 291 Cases. *The Journal Of Obstetrics And Gynaecology Research*, 46, 272 - 278. https://doi.org/10.1111/jog.14163.