Efficacy of hysteroscopic curettage and niche resection in type II and III cesarean scar pregnancies

Introduction To evaluate the efficacy and safety of hysteroscopic curettage combined with cesarean scar diverticulum canal-opening after focused ultrasound ablation surgery (FUAS) pretreatment in patients with type II and III cesarean scar pregnancy (CSP).Methods Clinical data of 105 patients with type II/III CSP treated between January 2019 and October 2022 were retrospectively analyzed. All patients received FUAS pretreatment. The observation group (n = 47) underwent hysteroscopic curettage combined with niche canal-opening, while the control group (n = 58) received hysteroscopic curettage alone. Surgical parameters, postoperative recovery, complications, reintervention rates, and menstrual outcomes were compared.Results The observation group had significantly shorter operation time [20 (15,25) vs. 25 (20,31) min, p = 0.001], less intraoperative blood loss [5 (5,10) vs. 10 (10,50) mL, p = 0.002], lower complication rate [4.3% vs. 17.2%, p = 0.038], and lower reintervention rate [4.3% vs. 19.0%, p = 0.023]. No between-group differences were observed in postoperative hemoglobin decline, hospital stay, vaginal bleeding duration, human chorionic gonadotropin normalization time, menstrual recovery time, or residual scar myometrial thickness (all p > 0.05). Among patients with preoperative prolonged menstruation, menstrual duration improved in both groups (p < 0.05), with a higher improvement rate in the observation group [75.0% vs. 23.1%, p = 0.005].Conclusions FUAS pretreatment combined with hysteroscopic surgery is safe and effective for type II/III CSP. Adding diverticulum canal-opening to hysteroscopic curettage further optimized surgical outcomes by reducing operation time, intraoperative blood loss, complication rates, and the need for reintervention, while also significantly improving prolonged menstruation. This combined strategy may serve as an optimized minimally invasive alternative for patients desiring fertility, though long-term reproductive safety requires further verification.