Textbook outcomes in patients with a cesarean scar pregnancy: A comprehensive analysis from a single Eastern center

Background Quality medical care is crucial in evaluating clinical results. This study assessed the value of medical quality control using the comprehensive indicator "textbook outcome" (TO) in patients with a cesarean scar pregnancy (CSP). Methods This study included 140 patients from a CSP cohort from April 2022 to May 2024. TO was characterized by the total removal of the gestational sac, lack of intraoperative complications, absence of severe postoperative complications, freedom from re-interventions, no unplanned admissions to the intensive care unit, postoperative hospital stay of ≤ 7 days, zero postoperative mortalities within 30 days post-surgery, and no readmission within 30 days post-surgery. Logistic regression was used to analyze factors contributing to non-TO. Results Overall, 119 (85.0%) achieved a TO. Significant differences were observed between the TO and non-TO groups in terms of the number of days with abdominal pain, number of days with vaginal bleeding, number of days without menstruation, history of cesarean section in a primary healthcare hospital, time from previous cesarean section to CSP, gestational sac size, and CSP classification (all P < 0.05). Most patients in the TO group received high-intensity focused ultrasound (HIFU) combined with hysteroscopy (53.8%), resulting in lower average intraoperative blood loss, length of hospital stay, and hospitalization cost compared to the non-TO group (all P < 0.05). The postoperative pain score in the TO group was lower (P = 0.002), and the time required for β-hCG levels to return to normal in the TO group was shorter than in the non-TO group (P = 0.025). Multivariate logistic analysis revealed that history of cesarean section at a primary hospital, CSP-III classification, and intraoperative blood loss exceeding 30 mL were independent risk factors for a non-TO (all P < 0.05), whereas HIFU combined with hysteroscopy was an independent protective factor against non-TO (P = 0.020). Conclusion In clinical practice, it is important to pay attention to patients with history of cesarean section in primary healthcare hospitals, CSP-III classification, and intraoperative blood loss exceeding 30 mL. HIFU combined with hysteroscopy can help patients with a CSP achieve a TO.