Conservative management of Caesarean scar pregnancies with systemic multidose methotrexate: predictors of treatment failure and reproductive outcomes

Zigron, Roy; Dior, Uri; Gilad, Ronit; Shushan, Asher; Benshushan, Abraham; Rottenstreich, Amihai

doi:10.1016/j.rbmo.2019.05.015

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…Complications were more frequent in women with a history of 3 or more cesarean section deliveries and with a myometrial thickness thinner than 2 mm [ 42 , 49 ]. The risk of hemorrhage during MTX treatment was 10% [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Successful pregnancies after MTX treatment have been reported, but reliable data confirming the effect of MTX on subsequent female fertility and the incidence of recurrent CSP are still lacking [ 39 , 49 ]. Based on the available publications, conception outcomes are much lower than with chemoembolization treatment or were not analyzed.…”

Section: Resultsmentioning

confidence: 99%

“…There are reports of safe and effective use of a combination of systemic and local administration of MTX for patients with CSP [ 57 , 58 ], but adverse effects (eg, nausea, vaginal spotting, and elevated liver enzymes) were noted. Having had more than 2 previous cesarean section and myometrial thickness <2 mm were independent factors associated with increased risk of complications and treatment failure [ 42 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Kłobuszewski,

Szmygin,

Nieoczym

et al. 2024

Med Sci Monit

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Cesarean scar pregnancy (CSP) is a rare but potentially dangerous condition that occurs when an embryo implants and develops within the scar tissue from a previous cesarean section. Treatment of cesarean scar pregnancy depends on several factors, including the gestational age of the pregnancy, the presence of complications, and the individual patient’s circumstances. We performed a systematic review of the published literature on management of cesarean scar pregnancy and the outcomes, complications, and effects on fertility. A systematic review of recent scientific literature published up to April 2023 in the databases PubMed, Google Scholar, and Web of Science was performed according to the PRISMA guidelines. We used the search keywords “cesarean scar pregnancy,” “methotrexate,” “systemic,” “chemoembolization,” and “uterine artery embolization.” The baseline search resulted in 413 articles. After the exclusion of 342 irrelevant articles, the abstracts and titles of the remaining 71 articles were read for potential inclusion, resulting in exclusion of a further 16 articles. Therefore, the full texts of 55 articles were investigated. Finally, 42 papers were included in the study. The main finding was that chemoembolization is more successful than systemic methotrexate therapy, and is associated with less blood loss and shorter hospital stay. Transarterial chemoembolization appears to be safe and effective method of treatment in patients with CSP and should thus be considered during multidisciplinary evaluation of these patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Kłobuszewski,

Szmygin,

Nieoczym

et al. 2024

Med Sci Monit

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“…Since the serum β-hCG level was not decreased as expected, multiple doses of MTX as a combination of systemic and local (injected into the sac) MTX were used. Levin et al reported that 29/36 cases (80.6%) were treated successfully by systemic injection of MTX, while the other 19.4% were treated with a combination of systemic and local (that is, intra-sac) MTX administration [9]. Bodur et al concluded that a primary systemic MTX administration was effective for a cesarean scar ectopic pregnancy before 8 weeks of gestational age, a β-hCG concentration of ≤ 12,000 mIU/ ml, and negative embryonic cardiac activity [10].…”

Section: Discussionmentioning

confidence: 99%

Cesarean scar pregnancy treatment: a case series

et al. 2021

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Background Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. Case presentation Four Iranian pregnant women aged 29–34 years who were between 5 to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. Conclusion When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.

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“…CSP is believed to occur when the fertilized ovum implanted on fibrous incision site of myometrium in a prior CS within 12 weeks [ 5 ]. Currently, novel treatments of CSP were developed, varying from medical management and minimally invasive surgical approach [ 6 – 9 ].…”

Section: Introductionmentioning

confidence: 99%

A study on the timing of uterine artery embolization followed by pregnancy excision for cesarean scar pregnancy: a prospective study in China

Yang

et al. 2021

BMC Pregnancy Childbirth

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Background Cesarean scar pregnancy (CSP) remains a sporadic and special form of ectopic pregnancy in which the fertilized ovum is implanted on a previous cesarean scar within 12 weeks. This study aims to evaluate the optimal time interval between uterine artery embolization (UAE) and curettage modalities in order to provide the best clinical outcomes. Methods From January 2018 to December 2020, we recruited 61 patients with CSP. They were randomly divided into two groups depending on whether the time interval between UAE and dilatation and curettage (D&C) requires additional hospitalization: 31 patients received prophylactic UAE followed by D&C on the same day (0–12 h; group A) and 30 patients need hospitalization (12–72 h; group B). The clinical characteristics, diagnostic data, and outcomes of the two groups were compared and analyzed. Results A total of 59 (96.72%) cases had responded well to the first treatment. One patient in each arm undergone retreatment, but none of the 61 patients needed additional hysterectomy. There was no considerable relationship between the two groups with respect to the intraoperative hemorrhage during D&C, serum index (containing β-hCG, hemoglobin, CRP, and D-dimer) on the first day after D&C, side effects (containing fever and abdominal pain), renal, hepatic, and coagulation function, time of CSP residual mass disappearance, and hospitalization cost. The time of serum β-hCG resolution after surgery was 41.22 ± 14.97 days in group A and 66.67 ± 36.64 days in group B (P = 0.027), and group A treatment resulted in a shorten hospital stay as compared with group B (4.81 ± 2.74 days vs. 6.80 ± 2.14 days, P < 0.001). However, the average hourly serum β-hCG decrease rate within 24 h and the leukocytes on the first day after D&C in group B were superior than in group A (P < 0.050). Conclusion For patients with CSP, UAE followed by D&C on the same day (0–12 h) appears to have more advantages in hospitalization and recovery time, while the long time interval (12–72 h) may have a lower risk of inflammation and a more rapid decrease in serum β-hCG level within 24 h after D&C surgery. The treatment of CSP should be individualized based on the conditions of patients.

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Conservative management of Caesarean scar pregnancies with systemic multidose methotrexate: predictors of treatment failure and reproductive outcomes

Cited by 16 publications

References 27 publications

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Advances in Treating Cesarean Scar Pregnancy: A Comprehensive Review of Techniques, Clinical Outcomes, and Fertility Preservation

Cesarean scar pregnancy treatment: a case series

A study on the timing of uterine artery embolization followed by pregnancy excision for cesarean scar pregnancy: a prospective study in China

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