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Recording available 2/16-5/2

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Poster Session 2

Category: Ultrasound/Imaging

Poster Session 2

(407) Transvaginal ultrasound-guided treatment of live cesarean scar pregnancies

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Alexa L. Cohen, MD

University of Miami
Miami, Florida, United States

Coauthor(s)

LD

Leeann Dar

Montefiore Medical Center
Bronx, New York, United States
FE

Fatima Estrada Trejo, MD

Montefiore Medical Center
Montefiore Medical Center, New York, United States
OR

Ohad Rotenberg, MD

Montefiore Medical Center
Bronx, New York, United States
Pe'er Dar, MD

Professor and Director, Division of Fetal Medicine
Montefiore Medical Center
Bronx, New York, United States
GD

Georgios Doulaveris, MD

Maternal Fetal Medicine Attending
Montefiore Medical Center/Albert Einstein College of Medicine
Montefiore Medical Center/Albert Einstein College of Medicine, New York, United States

Objective:

Despite a variety of interventions proposed for managing live cesarean scar pregnancies (CSP), there is a paucity of data on outcomes, particularly in the late first trimester. Our study aimed to assess the safety and efficacy of transvaginal ultrasound (TVU)-guided feticide in the treatment of live CSP.

Study Design:

A retrospective analysis of all live CSP cases treated with TVU-guided feticide at a single academic institution from 2010-2023. Patients with prior intervention or who received systemic methotrexate (MTX) were excluded. TVU-guided feticide, with administration of intracardiac potassium chloride and/or intrasac MTX was performed in-office for all cases using a 20-gauge needle under local anesthesia. Interval suction curettage (D&C) was offered to all patients after a negative bHCG. Primary outcome was successful treatment defined as complete pregnancy resolution not requiring further unplanned intervention. Outcomes were compared between early (5-8 weeks) and late (9-13 weeks) first trimester. Secondary outcomes included complications, rate of bHCG decrease a week following treatment, time to negative bHCG, time to sonographic resolution, and rate of interval D&C.

Results:

95 patients with CSP presented to our institution: 55 live CSP and 51 without prior intervention. Successful treatment was achieved in 47 patients (92.2%) with four requiring hysterectomy: two due to bleeding, and two due to infection. Overall, 35 patients (68.6%) were diagnosed in the early first trimester and 16 patients (31.4%) in the late first trimester. Demographics were comparable between groups. Complete resolution rates were 33/35 (94.3%) for early versus 14/16 (87.5%, p=0.5) for late first trimester. Groups were similar for rate of complications, decrease of bHCG a week after treatment, time to negative bHCG, time to sonographic resolution, and rate of interval D&C.

Conclusion:

TVU-guided feticide emerges as a safe and efficacious first-line treatment for live CSP throughout the first trimester.