Abstract To propose a novel procedure as a safe and effec-tive treatment for cesarean scar pregnancy (CSP), a cohort study was initiated in patients diagnosed with CSP and treated with transvaginal hysterotomy from December 2009 toMarch 2013, either as a primary or secondary therapy. All diagnoses were confirmed by both sonography and pathology, either a gestational sac or residual tissue after termination of pregnan-cy or miscarriage in the cesarean section scar. Basic clinical characteristics and perioperative data were collected and ana-lyzed. A total of 40 patients were included. The mean age was 32.88±4.55 years. The mean size of gestational sacs of the CSPmass at diagnosis was 33.78±13.14mm. Mean serumβ-hCG level at diagnosis was 47379.73±45285.10 IU/L. Mean operative time was 57.25±24.52 min. Mean postoperative hemoglobin dropwas 1.635±0.906 g/dL. Complications were one case of bacteremia and two cases of hematoma. Mean hospital stay after surgery was 4.95±2.62 days. Mean serum β-hCG levels decreased by 88.5, 93.5, and 96.5 % at postop erative day 2, 4, and 6, respectively. All patients’ β-hCG levels returned to normal range within 1 month after surgery. Transvaginal hysterotomy with removal of ectopic pregnancy
tissue and repair of cesarean scar defect is a promising approach to manage CSPs, with a short hospital stay, low postoperative pain, blood loss, and cost.