1222 Conservative Management of Cesarean Scar Pregnancies with Systemic Multidose Methotrexate: Predictors of Treatment Failure and Reproductive Outcomes

Abstract

Study Objective The role of conservative management of CSP has been previously reported with conflicting results reported. In this retrospective study, we aimed to further evaluate its role and better delineate the subsequent reproductive outcomes Design A retrospective cohort study. Setting A large university hospital (Hadassah Medical Center Hospitals, Israel, Jerusalem) between November 2014 to April 2017 Patients or Participants All patients diagnosed with a CSP and treated by intention of conservative management with systemic methotrexate (MTX). Interventions A comparison of maternal and gestation characteristics was performed between treatment success and failure groups Measurements and Main Results Thirty seven cases of CSP were encountered. Overall, 29/37 (78.3%) were treated by systemic injection of MTX while the other 21.7% had combined systemic and local (i.e. intra-sac) MTX treatment. Invasive intervention was needed in 5 (13.5%) cases (failure group). Cases who were converted to surgical treatment had higher number of previous cesarean deliveries (median 4 vs. 2, p=0.002). In logistic regression modeling, the number of prior cesarean deliveries in the past was the only factor found independently associated with conversion to surgical management Odds Ratio 2.02, 95 % Confidence Interval 1.03,3.94. Majority of future pregnancies had term pregnancy with one preterm delivery due to severe intrauterine growth restriction Conclusion Systemic MTX therapy is a safe and effective strategy for the treatment of CSP with favorable subsequent reproductive results and a low conversion rate for surgical management. Patients with high order of previous cesarean deliveries should be considered for early surgical treatment rather than a medical one.