Quality medical care is crucial in evaluating clinical results. This study assessed the value of medical quality control using the comprehensive indicator “textbook outcome” (TO) in patients with a cesarean scar pregnancy (CSP). This study included 140 patients from a CSP cohort from April 01, 2022 to May 31, 2024. TO was characterized by the total removal of the gestational sac, lack of intraoperative complications, absence of severe postoperative complications, freedom from re-interventions, no unplanned admissions to the intensive care unit, postoperative hospital stay of ≤7 days, zero postoperative mortalities within 30 days post-surgery, and no readmission within 30 days post-surgery. Logistic regression was used to analyze factors contributing to non-TO. Overall, 119 (85.0%) achieved a TO. Significant differences were observed between the TO and non-TO groups in terms of the number of days with abdominal pain, number of days with vaginal bleeding, number of days without menstruation, history of cesarean section in a primary healthcare hospital, time from previous cesarean section to CSP, gestational sac size, and CSP classification (all P < .05). Most patients in the TO group received high-intensity focused ultrasound (HIFU) combined with hysteroscopy (53.8%), resulting in lower average intraoperative blood loss, length of hospital stay, and hospitalization cost compared to the non-TO group (all P < .05). The postoperative pain score in the TO group was lower ( P = .002), and the time required for β-hCG levels to return to normal in the TO group was shorter than in the non-TO group ( P = .025). Multivariate logistic analysis revealed that history of cesarean section at a primary hospital, CSP-III classification, and intraoperative blood loss exceeding 30 mL were independent risk factors for a non-TO (all P < .05), whereas HIFU combined with hysteroscopy was an independent protective factor against non-TO ( P = .020). Our findings highlight that patients with a history of cesarean section managed in primary healthcare hospitals, CSP-III classification, and intraoperative blood loss exceeding 30 mL are independent risk factors for adverse outcomes in CSP management. Notably, the combination of HIFU and hysteroscopy effectively facilitates the achievement of TO in these high-risk patients, offering a minimally invasive therapeutic option. These results provide actionable clinical guidance for prioritizing monitoring and intervention in at-risk groups.

Previous observational clinical studies have found a causal relationship between neurotic personality traits and various disorders. However, the relationship between neurotic personality characteristics and pre-eclampsia (PE) is not unclear. Two-sample Mendelian randomization (MR) was employed to examine the influence of neurotic personality traits on the risk of PE. From the Finnish genome-wide database, we identified 32 single-nucleotide polymorphisms linked to neuroticism personality traits, excluding 7 confounding variables related to blood pressure and BMI. The number of tool variables associated with PE was 25. Causality was assessed using inverse variance weighting, weighted median, MR-Egger, and weighted model methods. Sensitivity analyses, such as Cochran’s Q statistic, MR-Egger intercept, MR pleiotropy residual sum and outlier, and leave-one-out analysis, were conducted to identify potential heterogeneity and horizontal pleiotropy. The present 2-sample MR study did not reveal any genetic associations between neuroticism and PE. A 2-sample Mendelian randomization analysis of 12 dichotomous neuroticism items indicated that genetic predisposition to worrying elevates the risk of PE. The inverse variance weighted method produced an odds ratio (OR) of 2.23 (95% CI: 1.36–3.65, P < .05), while the weighted median analysis indicated an OR of 2.41 (95% CI: 1.20–4.85, P < .05). However, there were no significant correlations between the MR Egger and weighted modes. This study found no genetic causal link between neuroticism and PE; however, carriers may have a genetically increased risk of PE, offering a more reliable foundation for future prevention efforts.