ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Magnetic Resonance Imaging–Based Classification of Cesarean Scar Pregnancy: Prediction of Intraoperative Blood Loss and the Role of Preoperative Uterine Artery Embolization
Provisionally accepted
- 1Department of Radiology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
- 2Department of Radiology, People's Hospital of Quzhou, Quzhou, China
- 3Department of Radiology, Quzhou Maternal & Child Health Care Hospital, Quzhou, China
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Objective: To establish a magnetic resonance imaging (MRI)–based classification system for cesarean scar pregnancy (CSP), assess its ability to predict intraoperative blood loss, and evaluate the effectiveness of prophylactic uterine artery embolization (UAE). Methods: Ninety-eight women diagnosed with CSP who underwent MRI evaluation between May 2016 and September 2023. MRI-based classification of CSP into three subtypes according to sac morphology, vascular characteristics, and scar myometrial thickness. Subgroups were further stratified by preoperative UAE status. Intraoperative blood loss during pregnancy termination, evaluated by regression analysis and intergroup comparison. Results: Thirty-five patients were classified as type I, 35 as type II, and 28 as type III. Type I CSPs typically showed simple cystic sacs with minimal vascularity, while type II exhibited moderate vascularity and mixed cystic-solid features. Type III was characterized by large mixed cystic-solid sacs with prominent vascular flow voids, vascular lakes, and arteriovenous fistulas. Median intraoperative blood loss was 20 mL for type I, 50 mL for type II, and 265 mL for type III (p < 0.001). Multiple linear regression confirmed type III as the strongest independent predictor of hemorrhage (β = 327.2, p < 0.001). Among type III patients, preoperative UAE significantly reduced blood loss (p < 0.001), whereas, based on the limited data from this study, no significant benefit of preoperative UAE was observed in patients with type I or type II. Conclusion: MRI classification provides a reliable framework to stratify hemorrhage risk in CSP. Type III is associated with substantial intraoperative bleeding, and preoperative UAE is highly effective in mitigating this risk. Incorporating MRI classification into routine assessment may guide individualized management and improve surgical outcomes.
Keywords: Cesarean scar pregnancy, dilation and curettage, intraoperative hemorrhage, Magnetic Resonance Imaging, Uterine Artery Embolization
Received: 28 Oct 2025; Accepted: 02 Jan 2026.
Copyright: © 2026 Li, Li, Tong, Liu, Wang and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Fei Wang
Xiaojun Yang
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