Evaluation of treatment of previous cesarean scar pregnancy with methotrexate: a systematic review and meta-analysis

Abstract

Background Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP. Method This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I2 index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2. Results In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7–93.5%), and complication was 9% (95% CI: 6.3–12.8%). Conclusion The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.

Local Methotrexate Injection Followed by Dilation and Curettage for Cesarean Scar Pregnancy: A Prospective Non-randomized Study

“…Several approaches have been shown to be safe and feasible for the treatment of CSP (4). Methotrexate has been widely used in treating CSP, including systemic and local injection (9). Recently, evidence suggests that systemic methotrexate is not a suitable option for CSP because of its lower success rate and elevated risk of side effects (4).…”

“…Transvaginal ultrasound is the primary method of diagnosing CSP (8). Although a variety of modalities for treatments of CSP have been reported recently, including systemic or local injection of methotrexate, hysteroscopy, dilation and curettage (D&C), surgical resection, and uterine artery embolization (UAE) (9)(10)(11)(12), there is no consensus on the optimal treatment for patients who desire to maintain fertility (13). Uterine artery embolization is widely used and has been demonstrated to be effective in reducing the risk of bleeding while treating CSP (12), but it is associated with potential complications (14,15).…”

Conservative Management of Cesarean Scar Pregnancy: A Case Report and Literature Review

“…Conservative treatment with systemic MTX is considered the treatment of choice in clinically stable patients with a desire to preserve fertility [ 1 , 6 , 7 , 16 ].…”

“…Methotrexate (MTX) is an antimetabolite drug that has been used in the treatment of molar and ectopic pregnancies, including CSP [ 6 , 7 ]. Although MTX is considered a safe and effective therapy, the optimal dose, route, and protocol for its use have yet to be determined for CSP [ 6 ].…”

“…Despite the large number of clinical reports and different therapeutic approaches, there is no consensus on the treatment of CSP [5]. Methotrexate (MTX) is an antimetabolite drug that has been used in the treatment of molar and ectopic pregnancies, including CSP [6,7]. Although MTX is considered a safe and effective therapy, the optimal dose, route, and protocol for its use have yet to be determined for CSP [6].…”