Hysteroscopic Approach of Caesarean Scar Pregnancy: A Systematic Review

Background and Aims: Caesarean scar pregnancy (CSP) is an emerging clinical condition as the rate of caesarean deliveries has been increasing worldwide. Although, hysteroscopic management is promising among various small studies that use different methodologies. The given systematic review was intended to assess the efficacy and safety of hysteroscopic treatment of CSP, success rates of various techniques, patient selection criteria, and reproductive outcomes after treatment. Methods: A systematic literature review was done as per PRISMA protocol, and the studies were identified using MEDLINE, Embase, Cochrane CENTRAL and Web of Science databases published from January 2020 up to December 2025. The inclusion criteria included original studies that contain measurable results of hysteroscopic management of CSP. The quality assessment utilised appropriate tools aligned with the study design, and thematic analysis was conducted to synthesise findings across all included studies based on inclusion criteria. Key Results: A total of ten studies, after proper eligibility evaluation of 26 studies, were applied in the final theme analysis, and they all fitted the inclusion criteria. From the included studies the overall success rate of CSP treatment with hysteroscopic procedures was high and reached 91 percent. Among studies, complications following hysteroscopic approach as hemorrhage and hysterectomy, were less than 1 precent of cases. Patient selection based on CSP classification was found to be very important as the success rates were 89.9 and 88.9 with Type I and Type II CSP respectively, as against 50 percent with Type III lesions. Myometrial thickness more than 3mm seems to be important prognostic feature for the success of hysteroscopy in such cases. Regarding maintenance of fertility potential, pregnancy results after treatment of CSP were promising in many published studies. Conclusions: Hysteroscopic management can be an effective and safe first-line treatment to appropriately selected CSP patients. priority should be given to vacuum-assisted methods because they have higher safety profile. A precision medicine model that includes CSP categories, anatomical and patient aspects optimises. The evidence advocates hysteroscopic intervention as fertility-sparing option with good reproductive results although standard protocols and further research is needed to achieve optimal results.