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Poster Session 2

Category: Clinical Obstetrics

Poster Session 2

(672) Adverse Outcomes in Cesarean Scar Ectopic Pregnancies Continuing into Mid- to Late-Trimesters: A Meta Analysis

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Shuai Zeng, Medicial Master (he/him/his)

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)

Coauthor(s)

JQ

Jiangxue Qu, PhD

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
HS

Huifeng Shi

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
HJ

Hai Jiang, PhD

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
JY

Jie Yan

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
YC

Yiwen Chong

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
YW

Yuanyuan Wang

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
LC

Lian Chen, MD

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)
YZ

Yangyu Zhao, MD

Peking University Third Hospital
Beijing, Beijing, China (People's Republic)

Objective:
Current guidelines recommend early termination for cesarean scar ectopic pregnancy (CSEP). However, some patients express strong preferences for pregnancy continuation. Existing studies on mid- to late-trimester outcomes remain sparse, heterogeneous, and derived from small cohorts. Crucially, the association between first-trimester ultrasonographic classifications and subsequent adverse outcomes has not been systematically evaluated. This study aims to comprehensively and quantitatively evaluate mid- to late-trimester outcomes for different subtypes of CSEP.

Study Design:
Comprehensive searches were performed in PubMed, Embase, Cochrane library, CNKI, Yiigle databases up to February 12, 2025. Eligible studies reporting outcomes of CSEP continued beyond 14 weeks’ gestation were included. Data were synthesized using pooled incidence rates and odds ratios (OR) with 95% confidence interval (CI).

Results:
61 studies were included, of which 20 studies provided data suitable for meta-analysis (Figure 1). The pooled incidences for placenta accreta spectrum (PAS) and hysterectomy were 0.90 (95% CI 0.81-0.96) and 0.39 (95% CI 0.22-0.57), respectively. 85% (95% CI 0.73-0.94) of pregnancies continued beyond 28 weeks, but only 19% (95% CI 0.10-0.30) beyond 37 weeks (Figure 2). Risk analysis indicated significantly elevated risks of invasive PAS and hysterectomy in type III CSEP compared to type I (OR 8.81, 95% CI 1.53-50.70) and II (OR 9.92, 95% CI 1.96-50.29). Exogenous CSEP also posed significantly greater risks for invasive PAS (OR 7.94, 95% CI 1.51-41.72) and hysterectomy (OR 9.22, 95% CI 2.66-31.98), compared to endogenous CSEP. Residual myometrial thickness (RMT) ≤ 3 mm substantially increased the risk of invasive PAS risk (OR 7.24, 95% CI 2.47-21.25).

Conclusion:
Ultrasonographic classification and early measurement of RMT proved valuable for risk stratification in continuing CSEP into mid- to late-trimesters. Pregnancies classified as type I, endogenous CSEP or RMT ≤ 3 mm showed more favorable outcomes, while type III, exogenous, or RMT > 3 mm cases carried higher risks of adverse events.