The effect of ultrasound-guided suction curettage on reproductive outcomes in patients with cesarean scar pregnancy

Objective: This study aims to evaluate reproductive and pregnancy outcomes in patients with cesarean scar pregnancies (CSP) treated by suction curettage. Methods: This retrospective observational study included 85 patients with CSP treated by suction curettage in a university hospital between 2013-2017. Reproductive status of the patients who could be reached by phone was inquired at 6-month intervals for three years. Results: Hospital records and telephone follow-up data of the 44 patients who completed follow-up were analyzed. Nineteen patients did not desire pregnancy, while 25 patients reported wishing to conceive again. Twenty-three of these patients (92%, 23/25) conceived spontaneously, 2 of them (8%, 2/25) unable to conceive due to unexplained secondary infertility. Mean length of time from CSP to subsequent pregnancy was 12.3 months (range 2-36 months). Of these pregnancies, 11 (47.8%, 11/23) resulted in birth without any obstetrical problems. Six patients (26%, 6/23) experienced miscarriage, and three patients (13%, 3/23) recurrent cesarean scar pregnancies. Two patients (8.6%, 2/23) had abnormal placental invasion and one patient (4.3%, 1/23) tubal ectopic pregnancy. The live birth rate among the pregnancies was 52.1% (12/23). Conclusion: There is no consensus on the primary treatment regarding the reproductive outcomes. Suction curettage is a successful, reliable, inexpensive and easily applicable treatment when appropriate patients are selected. Furthermore, it has a minimal negative effect on fertility, so it can be considered as a first-line treatment option in patients who wish to have children in the future.