Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: Single‐center experience

Abstract

Systemic multidose MTX therapy is an effective and safe treatment method for CSP. However, further studies are needed to compare the safety, effectiveness and reproductive outcome of different treatment modalities in CSP.

Conservative management of cervical ectopic pregnancy: Single‐center experience

“…One possible explanation for this is that we used a more intense treatment protocol involving at least four successive doses of systemic MTX. In addition, according to our experience, β‐hCG in cesarean scar pregnancy increased more after treatment than in tubal ectopic pregnancy, and then took longer to return to normal . Therefore, we followed β‐hCG after treatment longer than previously reported and observed the later decline as expected.…”

Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only

“…In particular, when the β -hCG level at the time of diagnosis was higher than 20,000 mIU/ml, or when β -hCG level after local MTX injection was elevated, additional systemic MTX administration was performed [5]. However, systemic MTX administration can cause complications, such as nausea, stomatitis, alopecia, bone marrow, depression, and pneumonitis [9]. Therefore, it would be beneficial if local treatment without systemic MTX was sufficient to treat CSP with higher β -hCG levels.…”

Cesarean scar ectopic pregnancy: imaging features, current treatment options, and clinical outcomes

“…MTX is the consensus treatment for tubal and cervical ectopic pregnancies with an early gestational age (less than 9 weeks), embryo smaller than 10 mm, serum B-hCG levels less than 10,000 mIU/mL, and lack of cardiac activity [3]. The success of MTX in treating CSEP ranges from 57 to 100 % [22][23][24] in published case series; this variability may be attributed to the lack of established protocols. Methotrexate has been shown to be effective at a dose of 50 mg/m 2 when the B-hCG level is less than 5000 mIU/ mL [25,26].…”

“…The natural course of CSEP may be a spontaneous abortion [3,[17][18][19][20] even when carriage to term is desired. Many cases result in surgical intervention for severe hemorrhage or uterine rupture in the early 2nd trimester [21,22].…”