Skip to main content
SMFM 2026 Pregnancy Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Additional registration fee required
Additional registration fee required
Faculty have requested this content not be shared outside of the session
Faculty have requested this content not be shared outside of the session
CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
Recording available 2/16-5/2
Recording available 2/16-5/2
AIUM Credit
AIUM Credit
Foundation Awardee
Foundation Awardee
Poster Icons
Abstract Award
Abstract Award
Foundation Awardee
Foundation Awardee

Poster Session 4

Category: Clinical Obstetrics

Poster Session 4

(1137) Evaluating Outcomes of Expectantly Managed CSEP in a Histologically Confirmed PAS Cohort

Thursday, February 12, 2026
3:30 PM - 5:00 PM  
Objective:
To compare maternal and neonatal outcomes in patients with and without 1st trimester evidence of cesarean scar ectopic pregnancy (CSEP) in a cohort with histologically confirmed placenta accreta spectrum (PAS).

Study Design:
In this single-center retrospective study of patients with confirmed PAS (2012–2024), patients were included if: 1) 1st trimester ultrasound images were available, or 2) an outside diagnosis of CSEP existed with referral for continuation of pregnancy. Two blinded MFM subspecialists independently reviewed all available 1st trimester images using validated criteria for categorization. Cases included those with a CSEP diagnosis either by retrospective image review or established prior to referral. Controls lacked evidence of CSEP on image review.

Results:

Among 273 histologically confirmed PAS cases, 47 (17.2%) met inclusion criteria. CSEP was identified in 31 (66.0%): 6 (19.4%) by outside diagnosis and 25 (80.6%) by expert imaging review. Sixteen (34.0%) patients did not have a CSEP by review of available ultrasound images. Baseline demographics were similar. CSEP patients had more prior cesareans and higher gravidity and parity (p< 0.01).  There were no differences in gestational age at delivery, intra-operative blood loss, transfusions, or peri-operative morbidity between groups. Percreta was more prevalent in the CSEP group (41.9% vs 12.5%; p = 0.04). Live birth rates were similar between groups (93.5% vs. 93.8%; p = 0.98) without any significant differences in Apgar scores.

Conclusion:
Patients with a diagnosis of CSEP in the 1st trimester did not experience greater maternal or neonatal morbidity compared to those with no evidence of CSEP in a cohort of patients with histologically confirmed PAS. These findings challenge current guidelines that strongly recommend early termination of CSEP. The study provides support for the option of expectant management in appropriately selected and counseled patients receiving care with experts in PAS. The trend toward more invasive pathology in the CSEP group underscores the importance of early identification and coordinated planning.