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Reproductive outcome after cesarean scar pregnancy: A systematic review and meta-analysis.

  • Morlando, Maddalena1
  • Buca, Danilo2
  • Timor-Tritsch, Ilan3
  • Cali, Giuseppe4, 5
  • Palacios-Jaraquemada, Jose6
  • Monteagudo, Ana7
  • Khalil, Asma8
  • Cennamo, Carmen1
  • La Manna, Viviana1
  • Liberati, Marco2
  • D'Amico, Alice2
  • Nappi, Luigi9
  • Colacurci, Nicola1
  • D'Antonio, Francesco2
  • 1 Department of Woman, Child and General and Special Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy. , (Italy)
  • 2 Center for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy. , (Italy)
  • 3 Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University SOM, New York, NY, USA.
  • 4 Department of Obstetrics and Gynecology, Azienda Ospedaliera Villa Sofia Cervello, Palermo, Italy. , (Italy)
  • 5 Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy. , (Italy)
  • 6 Center for Medical Education and Clinical Research (CEMIC), University Hospital, Buenos Aires, Argentina. , (Argentina)
  • 7 Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • 8 Fetal Medicine Unit, St George's Hospital, London, UK.
  • 9 Fetal Medicine Unit, Department of Medical and Surgical Sciences, Department of Obstetrics and Gynecology, University of Foggia, Foggia, Italy. , (Italy)
Published Article
Acta Obstetricia Et Gynecologica Scandinavica
Wiley (Blackwell Publishing)
Publication Date
Oct 01, 2020
DOI: 10.1111/aogs.13918
PMID: 32419158


To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). MEDLINE, Embase and databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non-surgical) was also performed. Random effect meta-analyses of proportions were used to analyze the data. Forty-four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non-surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively. Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non-surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long-term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations. © 2020 Nordic Federation of Societies of Obstetrics and Gynecology.

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