The management of cesarean scar pregnancy using ultrasound-guided dilation and curettage.

To evaluate the potential risk factors associated with failed ultrasound-guided dilation and curettage (D&C) treatment of cesarean scar pregnancy (CSP).Retrospective study.University hospital.Fifty-one patients diagnosed with CSP and treated with ultrasound-guided D&C at Shanghai General Hospital of Shanghai Jiao Tong University.Lesion resection using ultrasound-guided D&C.Clinical characteristics, vaginal bleeding, abdominal pain, the size of the gestational sac, cardiac motion, blood flow around the gestational sac, cesarean scar thickness and serum β-HCG levels were compared between the successful operation group and the failed operation group. The cesarean scar thickness was the main risk factor that determined the success of ultrasound-guided D&C. The success rates were 50% and 97.67% for those with cesarean scars less than three millimeters thick and those with scars more than three millimeters thick, respectively (P=.001). The success rate was also associated with the abundance of blood flow surrounding the capsule and with the size of the gestational sac (P<.005). Surgical success was not affected by abnormal vaginal bleeding, abdominal pain, cardiac motion or serum β-HCG levels.Ultrasound-guided D&C is the first choice for treating CSP if the cesarean scar is more than three millimeters thick, blood flow is not abundant, and the maximum diameter of the gestational sac is less than 30 millimeters. A transabdominal procedure is preferred for patients with high risk factors.