Assessment of the factors associated with initial treatment failure in cesarean scar pregnancy

This study identified factors associated with initial treatment failure in cesarean scar pregnancy (CSP) and provided insights to improve management strategies and patient outcomes. This retrospective study involved 451 electronic medical records of patients with CSP who were treated between January 2017 and June 2024, of whom 76 experienced initial treatment failure and 375 achieved initial treatment success at our hospital. Multiple logistic regression analyses were performed to identify risk factors for initial treatment failure. The failure rate of ultrasound-guided evacuation was significantly higher than that of hysteroscopy-guided evacuation, vaginal excision of CSP lesions, and laparoscopic excision of CSP lesions ( P  < .001). Multiple logistic regression analysis revealed that independent risk factors for initial treatment failure in CSP patients included baseline serum β-human chorionic gonadotropin (β-hCG) (odds ratio (OR) = 2.361, 95% confidence interval (CI) = 1.108–5.029, P  = .026), initial treatments (OR = 0.632, 95% CI = 0.486–0.823, P  = .001), gestational age (OR = 2.413, 95% CI = 1.319–4.415, P  = .004), gestational sac diameter (OR = 3.104, 95% CI = 1.492–6.456, P  = .002), and cesarean scar (CS) myometrial thickness measurement (OR = 0.233, 95% CI = 0.072–0.755, P  = .015). In conclusion, these findings indicate that ultrasound-guided evacuation is an independent risk factor for initial treatment failure. Therefore, individualized treatment selection for CSP should be based on baseline serum β-hCG levels, gestational age, gestational sac diameter, CS myometrial thickness measurement, and treatment modality. Additional evaluation may be necessary before proceeding with ultrasound-guided evacuation in patients presenting with multiple risk factors for treatment failure.