Unified management of cervical and cesarean scar pregnancies: A low-risk approach

Objective: To compare cervical pregnancy (CP) and cesarean scar pregnancy (CSP) in terms of risk factors, clinical presentation, and treatment outcomes, and to evaluate the feasibility of similar management strategies. Methods: This retrospective study included all CP and CSP cases diagnosed and treated between 2014 and 2022 in a tertiary gynecology department. Data were collected from electronic medical records and included demographics, medical history, clinical presentation, diagnosis, treatment, and follow up. Results: Among 899 ectopic pregnancies, 10 were CP and 32 were CSP. Compared with CP, CSP patients had higher gravidity (mean 4.2 ± 2.2), parity (mean 2.1 ± 1.1), and number of previous cesarean deliveries (mean 1.8 ± 1.1). No significant differences were observed in maternal age, smoking status, or use of assisted reproductive techniques. CP patients had higher human chorionic gonadotropin (hCG) levels at diagnosis (6247.51 ± 5738.7 IU/L vs. 23394.93 ± 25091.3 IU/L, P = 0.041). Both groups presented at similar gestational ages, though bleeding was more common in CP. CP treatments included surveillance (20%), methotrexate (20%), dilatation & evacuation (D&E) (20%), or a combination (40%). CSP treatments included methotrexate (9.4%), D&E (46.9%), or a combination (40.6%). No CSP cases were managed conservatively. Maternal morbidity was not reported. Three patients required blood transfusions, but no intensive care unit admissions or readmissions occurred. Conclusion: Although CP and CSP differ in certain clinical and demographic characteristics, similar treatment approaches may be feasible. Initial treatment with methotrexate followed by D&E appears promising, but further data are needed to confirm safety and effectiveness. Prospective studies are warranted to guide standardized protocols.