Identifying risk factors for recurrent cesarean scar pregnancy: a case-control study

Objective: To investigate risk factors for recurrent cesarean scar pregnancies. Design: Case-control study. Setting: University hospital. Patient(s): Twenty-one women with recurrent cesarean scar pregnancies and 42 women with single cesarean scar pregnancies. Intervention(s): None. Main Outcome Measure(s): Risk factors and historical factors that might be predisposing factors in recurrent cesarean scar pregnancy. Result(s): The risk factors of recurrent cesarean scar pregnancy were cesarean delivery history in rural community hospitals (odds ratio [OR] 4.75), thinner lower uterine segment (<= 5 mm; OR 7.10), gestational sac bulging into the uterovesical fold (OR 6.25), history of irregular vaginal bleeding or lower abdominal pain in an earlier cesarean scar pregnancy (OR 3.52), and early termination (% 56 days) of the first cesarean scar pregnancy (OR 5.85). Conclusion(s): These findings provide evidence for the prevention of recurrent cesarean scar pregnancy and early diagnosis of the disease. Early recognition and diagnosis of this disease might be feasible because of the identifiable risk factors. Clinicians should be aware of the possible existence of recurrence. An accurate and prompt diagnosis is crucial to avoid catastrophic complications such as uterine rupture, massive vaginal bleeding and placenta previa/ accreta, which might lead to hysterectomy. (C) 2014 by American Society for Reproductive Medicine.