Treatment-Based Recurrence of Scar Pregnancy: A Systematic Review of the Literature as a Tool for More Informed Decision-Making.

Objectives: Caesarean scar pregnancy (CSP) is a rare but potentially life-threatening ectopic pregnancy whose incidence has increased in recent years. Although several surgical and non-surgical treatments have been proposed, outcomes remain heterogeneous. This systematic review aimed to compare recurrence rates of CSP according to different treatment modalities and evaluate subsequent reproductive outcomes. Methods: A systematic search of Web of Science, Scopus, and PubMed identified studies published up to January 2026. The review followed PRISMA guidelines and SWiM reporting standards. Eligible studies included case reports, randomized controlled trials, prospective and retrospective cohort studies, and case series published in English. Only studies reporting women desiring future conception and specifying treatment type for recurrent CSP were included. Comparative analyses were restricted to treatment groups with at least 40 patients. Recurrence rates among five treatment groups were compared using the two-proportion z-test. Results: Overall, 1991 women treated for CSP were included. Of these, 636 (32%) desired future pregnancy, and 453 (71.1%) subsequently conceived. Fifty-four recurrent CSPs were reported, corresponding to a recurrence rate of 11.9%. Higher recurrence rates were observed after dilation and curettage with or without uterine artery embolization than after hysteroscopic treatment. Among women achieving a subsequent pregnancy, 60.3% resulted in viable intrauterine pregnancies, 27.6% were non-ongoing pregnancies, and 11.9% represented recurrent CSP. Conclusions: Among the treatment groups analyzed, hysteroscopic management was associated with lower observed recurrence rates compared with dilation and curettage-based approaches. However, these findings should be interpreted cautiously, as treatment allocation was not randomized and substantial heterogeneity in CSP characteristics, patient selection, and follow-up duration may have influenced the observed differences. Prospective comparative studies are required to determine whether these differences reflect true treatment effects.