Is suction curettage an effective treatment alternative for cesarean scar pregnancies?

OBJECTIVES: The study aims to evaluate the success rate of suction curettage (SC) as a first line treatment with or without use of foley balloon tamponade for cesarean scar pregnancy (CSP) and to determine the risk factors for failure of treatment.

STUDY DESIGN: The study was retrospective and included 36 CSP cases who underwent SC for treatment. Presence of pain with active bleeding and > 10 weeks of gestation were taken as the exclusion criterion. The procedure was performed under sonographic guidance. After the procedure, in patients who had a hemorrhage foley catheter was inserted into the uterine cavity. SC failure was defined as a requirement of secondary intervention. CSP types, myometrial thickness in the scar area, fetal cardiac activity, initial Beta human chorionic gonadotropin levels (β-HCG), history of vaginal delivery were compared between successful and failed groups.

RESULT: Of 36 patients, 31 had favorable results with SC ± foley balloon tamponade. Success rate was found to be 86 % (31/36) as the first line therapy. Foley catheter was applied for 23 patients, among them, four were in the failed group and 19 were in the favorable group. In the failed group, two patients had emergent laparotomy, two had repeat SC the day after the initial treatment and one patient was treated with systemic MTX. Fetal cardiac activity and presence of embryonic pole were not different between the groups (p = 1.000, p = 0.829 respectively). Myometrial thickness in the failed group was less than the successful group, this difference was significant (p = 0.033). CSP types, initial β-HCG levels and history of vaginal delivery were not different between the groups (p = 0.149, p = 0.372 and p = 0.404 respectively).

CONCLUSION: SC may be considered as a first line therapy for CSPs, and and in patients complicated with hemorrhage foley balloon tamponade can be used easily. Thinner myometrium at previous cesarean scar can be considered as a risk factor for failure of SC in patients with CSP.