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Peer-reviewedCC BY-NC-NDBMC pregnancy and childbirth

Human chorionic gonadotropin levels of cesarean scar pregnancy compared with those of other ectopic pregnancies: a retrospective cohort study.

  • Nobuyuki Kidera1,2
  • Tomonori Ishikawa3
  • Toshihiro Kawamura4
  • Naoyuki Miyasaka5
5 affiliations
  1. 1Denentoshi Ladies Clinic, 1-5-1 Azamino Aoba-ku, Yokohama-shi, Kanagawa-ken, 225-0011, Japan. [email protected].
  2. 2Department of Comprehensive Reproductive Medicine, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. [email protected].
  3. 3Department of Perinatal and Maternal Medicine (Ibaraki), Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
  4. 4Denentoshi Ladies Clinic, 1-5-1 Azamino Aoba-ku, Yokohama-shi, Kanagawa-ken, 225-0011, Japan.
  5. 5Department of Comprehensive Reproductive Medicine, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
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Abstract

Background

A cesarean scar pregnancy (CSP) is an abnormal implantation of an embryo within a previous cesarean section scar and considered a relatively rare form of ectopic pregnancy. We aimed to clarify the factors associated with CSP and evaluate whether differences in serum human chorionic gonadotropin (hCG) levels according to implantation site could contribute to early detection of CSP.Methods

We investigated 27,528 freeze-thawed embryo transfer cycles performed at our hospital between January 2016 and March 2025.Results

Forty-four patients were diagnosed with ectopic pregnancy: 26 had tubal pregnancies, 10 had cervical pregnancies, 5 had CSP, 2 had peritoneal pregnancy, and 1 had an ovarian pregnancy. History of myomectomy and ≥ 2 cesarean sections showed significant differences in the logistic regression analysis (history of myomectomy: P = 0.003, history of > 2 cesarean sections: P = 0.006). The hCG levels (median [interquartile range {IQR}]) for ectopic pregnancy were 58.15 mIU/mL (33.0-100.3) for cervix, 179.0 mIU/mL (150.8-294.1) for CSP, 24.3 mIU/mL (8.8-49.7) for fallopian tube, and 9.1 mIU/mL for others (ovary and peritoneal pregnancy). There was a significant difference between CSP and all non-CSP ectopic pregnancies combined (P = 0.001). The hCG level for clinical intrauterine pregnancy was 235.6 mIU/mL (136.6-382.4). There was a significant difference in hCG levels between clinical pregnancy and ectopic pregnancy (P < 0.001), but this significant difference disappeared when clinical pregnancy was compared with CSP (P = 0.607).Conclusions

Serum hCG levels in early pregnancy were higher in CSP than in other ectopic pregnancies. Even in the presence of high serum hCG levels during early pregnancy, CSP should be considered if there is a history of cesarean section, especially > 2 cesarean deliveries. The study included only five CSP cases, one of which was a duplicate case from a different treatment cycle. Consequently, the findings should be considered exploratory. Given the limited sample size, additional cases should be included and the statistical analysis repeated to ensure the robustness of the results.

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Cite

BibTeXRIS
BibTeX
@article{kidera2026human,
  title = {{Human chorionic gonadotropin levels of cesarean scar pregnancy compared with those of other ectopic pregnancies: a retrospective cohort study.}},
  author = {Nobuyuki Kidera and Tomonori Ishikawa and Toshihiro Kawamura and Naoyuki Miyasaka},
  journal = {BMC pregnancy and childbirth},
  year = {2026},
  month = jul,
  doi = {10.1186/s12884-026-09706-w},
  url = {https://europepmc.org/article/MED/42902206},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Human chorionic gonadotropin levels of cesarean scar pregnancy compared with those of other ectopic pregnancies: a retrospective cohort study.
AU  - Nobuyuki Kidera
AU  - Tomonori Ishikawa
AU  - Toshihiro Kawamura
AU  - Naoyuki Miyasaka
PY  - 2026
DA  - 2026/07/01
JO  - BMC pregnancy and childbirth
DO  - 10.1186/s12884-026-09706-w
UR  - https://europepmc.org/article/MED/42902206
AB  - Background  A cesarean scar pregnancy (CSP) is an abnormal implantation of an embryo within a previous cesarean section scar and considered a relatively rare form of ectopic pregnancy. We aimed to clarify the factors associated with CSP and evaluate whether differences in serum human chorionic gonadotropin (hCG) levels according to implantation site could contribute to early detection of CSP.Methods  We investigated 27,528 freeze-thawed embryo transfer cycles performed at our hospital between January 2016 and March 2025.Results  Forty-four patients were diagnosed with ectopic pregnancy: 26 had tubal pregnancies, 10 had cervical pregnancies, 5 had CSP, 2 had peritoneal pregnancy, and 1 had an ovarian pregnancy. History of myomectomy and ≥ 2 cesarean sections showed significant differences in the logistic regression analysis (history of myomectomy: P = 0.003, history of > 2 cesarean sections: P = 0.006). The hCG levels (median [interquartile range {IQR}]) for ectopic pregnancy were 58.15 mIU/mL (33.0-100.3) for cervix, 179.0 mIU/mL (150.8-294.1) for CSP, 24.3 mIU/mL (8.8-49.7) for fallopian tube, and 9.1 mIU/mL for others (ovary and peritoneal pregnancy). There was a significant difference between CSP and all non-CSP ectopic pregnancies combined (P = 0.001). The hCG level for clinical intrauterine pregnancy was 235.6 mIU/mL (136.6-382.4). There was a significant difference in hCG levels between clinical pregnancy and ectopic pregnancy (P < 0.001), but this significant difference disappeared when clinical pregnancy was compared with CSP (P = 0.607).Conclusions  Serum hCG levels in early pregnancy were higher in CSP than in other ectopic pregnancies. Even in the presence of high serum hCG levels during early pregnancy, CSP should be considered if there is a history of cesarean section, especially > 2 cesarean deliveries. The study included only five CSP cases, one of which was a duplicate case from a different treatment cycle. Consequently, the findings should be considered exploratory. Given the limited sample size, additional cases should be included and the statistical analysis repeated to ensure the robustness of the results.
SN  - 1471-2393
ER  -