IMR Press / CEOG / Volume 50 / Issue 10 / DOI: 10.31083/j.ceog5010222
Open Access Systematic Review
Treatment of Early Cesarean Scar Pregnancy with Double Balloon Catheter: A Systematic Review of the Literature
Show Less
1 Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
2 Obstetrics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
3 Department of Obstetrics and Gynecology, Spedali Civili di Brescia, 25123 Brescia, Italy
4 Department of Obstetrics and Gynecology, AOUI-University of Verona, 37129 Verona, Italy
*Correspondence: (Federico Ferrari)
Clin. Exp. Obstet. Gynecol. 2023, 50(10), 222;
Submitted: 31 May 2023 | Revised: 27 July 2023 | Accepted: 14 August 2023 | Published: 20 October 2023
(This article belongs to the Special Issue Management of Scar Ectopic Pregnancy)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Cesarean scar pregnancy (CSP) is a pregnancy in the scar area or “niche” from a prior hysterotomy, usually from a cesarean section. Currently, there is no consensus on the best management of CSP. A recent proposed treatment consists in placing a cervical ripening double-balloon catheter in the uterus under ultrasound guidance. Methods: In this systematic review on cervical ripening double-balloon catheter (CRDBC) treatment for CSP, we performed a literature search in electronic databases (Scopus, PubMed, MEDLINE, and Cochrane Library), from their inception until April 2023. The review was written following PRISMA guidelines for systematic reviews. Results: We identified 30 studies, and we finally analyzed 5 studies that met the inclusion criteria (one case report, two retrospective case series studies, a retrospective cohort study, and a retrospective multicentric case series). The total of pregnancies treated with CRDBC is 71, of which 8 (11%) were cervical pregnancies. The gestational age at treatment ranges from 5 + 0 to 10 + 1 gestational weeks, with variable human chorionic gonadotropin (hCG) levels (433–64.700 IU/mL). Most of the patients (73%) received adjuvant systemic methotrexate (MTX) and the catheter dwell time ranges from 1 to 5 days. Treatment was successful in all the patients. Maternal complications, defined as the need for transfusion, vaginal bleeding resulting in readmission, or requiring further treatment occurred in a small number of patients (4.2%). Conclusions: CRDBC was successful in the treatment of early CSPs. The effectiveness and safety of this minimally invasive method is testified to a small rate of maternal complications. Further prospective studies are warranted to explore this treatment modality. The study was registered on INPLASY (, registration number: INPLASY202390070 (doi: 10.37766/inplasy2023.9.0070).

cesarean scar pregnancy
double-balloon catheter
Fig. 1.
Back to top