A systematic review and meta-analysis of risk factors in the conservative treatment of cesarean scar pregnancy

Background: It is important to investigate the risk factors of the failure of conservative treatment for cesarean scar pregnancy in order to improve the success rate of treatment and preserve the fertility of patients. This article aims to investigate these factors by meta-analysis, so as to serve as a clinical reference. Methods: PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched. Literatures related to the treatment of cesarean scar pregnancy (CSP) were selected. Literatures were screened according to the inclusion and exclusion criteria, and the quality was evaluated. RevMan 5.3.5 software was used to conduct the meta-analysis on the factors of treatment failure. Results: A total of 7 articles were included in this study, involving 251 patients. Among them, there were 79 (31.5%) cases of conservative treatment failure. The results of the meta-analysis showed that more than 2 cesarean sections [OR =1.79, 95% CI: (0.94, 3.42), P=0.08], mass type CSP [OR =4.06, 95% CI: (2.11, 7.81), P<0.0001], serum beta-hCG value <20,000 U/L [OR =1.81, 95% CI: (0.92, 3.54), P=0.09], and pregnancy time over 3 years from last cesarean section [OR =4.12, 95% CI: (1.29, 13.08), P=0.02] were the risk factors for the failure of conservative treatment of CSP. Discussion: A total of 7 studies were included in this meta-analysis. The results showed that more than 2 cesarean sections, mass type CSP, serum beta-hCG value <20,000 U/L, and pregnancy time over 3 years from last cesarean section were risk factors for the failure of conservative treatment of CSP. Patients with the above risk factors should be screened and informed of the possibility of conservative treatment failure in a timely manner, and different methods should be considered for treatment.