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Poster Session 4

Category: Clinical Obstetrics

Poster Session 4

(1004) Maternal Morbidity in Cases of Cesarean Scar Ectopic Pregnancy Managed Expectantly

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Alesha M. White, MD (she/her/hers)

Maternal Fetal Medicine Fellow
University of Texas Southwestern Medical Center
Grand Prairie, Texas, United States

Coauthor(s)

Catherine Y. Spong, MD

Professor and Chair
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Elaine L. Duryea, MD

Associate Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States
Christina L. Herrera, MD

Assistant Professor
University of Texas Southwestern Medical Center
Dallas, Texas, United States

Objective:
The objective was to report maternal outcomes in cases of cesarean scar ectopic pregnancies (CSEPs) with cardiac motion (CM) managed expectantly.

Study Design:
Retrospective study of patients with a sonographic concern for cesarean scar implantation with CM and who were expectantly managed and delivered at a single institution between 2012 and 2025. Maternal outcomes for these patients are reported with specific emphasis on outcomes for patients who progressed to the third trimester. SMFM criteria for CSEP were applied.

Results:
During the study period 23 patients were diagnosed with a CSEP with CM, approximate incidence 1.1 per 10,000 pregnancies. Patients were diagnosed at a median gestational age of 6 weeks (6, 7). Three (13%) patients experienced a miscarriage in the first trimester, two of whom required hysterectomy due to persistent trophoblastic tissue. Four (17%) patients delivered in the second trimester, two required transfusion and all required hysterectomy. The remaining 16 (67%) delivered a livebirth in the third trimester (Figure). The median gestational age at time of delivery was 35 weeks (34, 36). All 16 required blood transfusion, and 13 (81%) required hysterectomy. Median EBL was 5000cc (2000, 6250) and median products transfused was 13 units (4, 31). Seven (41%) patients were transferred to the surgical intensive care unit after delivery and 7 (44%) experienced additional surgical complications. Fourteen patients had pathology available and of these 13 (93%) had pathology positive for PAS. All 13 of these patients met at least 5 of the 6 SMFM criteria for CSEP and had a pathology of 3A or higher (Table). The 3 (13%) patients who did not require hysterectomy each met fewer than 5 SMFM criteria for CSEP.

Conclusion:
While 67% of patients with a CSEP and CM will go on to deliver a liveborn infant in the 3^rd trimester, they experience very high rates of maternal morbidity including hemorrhage and hysterectomy, with almost universal progression to at least Grade 3A pathologic PAS. This information is important to allow for informed decision making on how best to mitigate maternal risk.