What question did this study set out to answer?

This study aims to evaluate the impact of prior cesarean scar pregnancy on obstetric outcomes, focusing on postpartum hemorrhage.

April 19, 2026Medical Science Monitor0 citationsOpen Access

Cesarean Scar Pregnancy and Subsequent Obstetric Outcomes: Focus on Postpartum Hemorrhage and Predictive Factors

XWXuemin WeiGuangxi University ZQZhida Qian

Key Points

This study aims to evaluate the impact of prior cesarean scar pregnancy on obstetric outcomes, focusing on postpartum hemorrhage.
Retrospective analysis of 15,439 women with prior cesarean section from January 2015 to December 2023.
Comparison between cases of cesarean scar pregnancy (n=83) and non-cesarean scar pregnancy (n=15,356).
Utilization of multivariate logistic regression for analyzing potential confounding factors.
CSP significantly increased postpartum hemorrhage rates (21.7% vs 1.7%; aRR 2.62).
CSP linked to higher rates of placenta previa (aRR 6.50) and placenta accreta spectrum (aRR 8.31).
Type II/III CSP, placenta previa, and PAS were independent predictors of postpartum hemorrhage.

Abstract

Background:Cesarean scar pregnancy (CSP), a rare form of ectopic pregnancy, is associated with substantial maternal morbidity and uncertain implications for subsequent pregnancies.This study evaluated the association between prior CSP and adverse obstetric outcomes in subsequent pregnancies; it also explored independent predictors of postpartum hemorrhage (PPH). Material/Methods:This retrospective single-center study included 15 439 women with prior cesarean section who delivered at a tertiary hospital (January 2015 to December 2023): 83 patients with CSP (Type I: n=24, ultrasound-guided uterine aspiration; Type II/III: n=59, uterine artery embolization UAE+aspiration) and 15 356 patients without CSP (non-CSP).Outcomes included PPH and secondary obstetric and neonatal complications.Multivariate logistic regression analysis was performed to address potential confounders.Results: CSP was associated with higher rates of PPH (21.7% vs 1.7%; adjusted relative risk aRR 2.62, P=0.024), placenta previa (aRR 6.50, P<0.001), placenta accreta spectrum (PAS; aRR 8.31, P<0.001), preterm delivery before 33 weeks (aRR 12.05, P<0.001), and low birth weight (aRR 4.19, P<0.001).Type II/III CSP (adjusted odds ratio aOR 17.90, P<0.001), placenta previa (aOR 5.12, P=0.046), and PAS (aOR 12.48, P<0.001) were independent predictors of PPH.UAE did not significantly affect PPH risk (P=0.628).Conclusions: CSP increases the risk of adverse obstetric outcomes.Type II/III CSP, placenta previa, and PAS are predictors of PPH.Prenatal assessments of CSP recurrence and placental disorders are critical for maternal-fetal safety.

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