Minqing Feng,1,* Huiling Shang,1,* Xiangdong Chen,1,* Jiebo Chen,1 Yunneng Cui,2 Hao Wang,1 Yuyi Ou,1 Xiaobin Huang1 

1Department of Gynecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People’s Republic of China; 2Department of Radiology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaobin Huang, Department of Gynecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People’s Republic of China, Tel +86-18038830078, Email kenhxb@fsfy.com Yuyi Ou, Department of Gynecology, Foshan Women and Children Hospital Affiliated to Guangdong Medical University, Foshan, Guangdong Province, 528000, People’s Republic of China, Tel +86-13760693623, Email 155467527hkr@gmail.com

Background: Cesarean scar pregnancy (CSP) is an uncommon and potentially life-threatening form of ectopic pregnancy characterized by embryo implantation within the scar tissue of a prior cesarean delivery.
Objective: The aim of this study is to compare clinical outcomes between focused ultrasound ablation surgery (FUAS) combined with suction curettage under hysteroscopic guidance and transvaginal debridement and repair surgery (TDRS) in the treatment of CSP.
Methods: A retrospective analysis was conducted on 78 patients with CSP and treated between 2017 and 2023. Among them, 25 received FUAS followed by hysteroscopic suction curettage, and 53 underwent TDRS. Key clinical indicators included intraoperative parameters, postoperative recovery, treatment costs, complications, and subsequent pregnancy outcomes.
Results: No significant differences were observed between the two groups in terms of intraoperative blood loss, decline rates of β-human chorionic gonadotropin and hemoglobin, or menstrual recovery. FUAS was associated with a significantly shorter operative time (34.96  ±  28.90 vs 60.13  ±  22.87 minutes, p < 0.001), but also with a longer hospital stay (7.92  ±  2.98 vs 5.38  ±  1.61 days, p < 0.001) and higher treatment costs (Ren Min Bi (RMB) 15,278  ±  3980 vs RMB 9443  ±  1570, p < 0.001). The treatment success rate was 76.00% for FUAS and 96.23% for TDRS (p=0.078). Among patients seeking fertility, post-treatment pregnancy rates were 71.43% in the FUAS group and 76.47% in the TDRS group (p > 0.05). No procedure-related complications were reported in either group.
Conclusion: Both FUAS combined with curettage and TDRS demonstrated safety and effectiveness in the treatment of CSP, with favorable post-treatment fertility outcomes. TDRS was associated with shorter hospitalization and lower medical costs and may be preferable for certain CSP subtypes, such as type III. Treatment selection should be individualized based on clinical characteristics.

Keywords: cesarean scar pregnancy, focused ultrasound ablation surgery, suction curettage under hysteroscopic guidance, transvaginal debridement and repair surgery