Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy.

Abstract

To assess the safety and efficacy of local intra-gestational sac methotrexate injection followed by dilation and curettage (D&C) in treating cesarean scar pregnancies (CSP). Medical records of CSP patients treated with local intra-gestational sac methotrexate injection followed by dilation and curettage were analyzed at the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China. Thirty-one patients were included in this study. The mean gestational age, sac diameter and thickness of the uterine scar were 49.6±7.7days, 1.8±0.6cm and 0.30±0.15cm, respectively. The median pretreatment serum β-human chorionic gonadotropin (β-HCG) level was 40,887mIU/mL, with the 25th and 75th percentiles at 19,852 and 74,552, respectively. The median blood loss during D&C was 20mL with the 25th and 75th percentiles at 10mL and 50mL. Following D&C, a Foley's balloon catheter compression was implanted in 26 (83.9%) patients due to active uterine bleeding. All patients had a β-HCG regression time of ≤ 4weeks after D&C. While 30 patients (96.8%) had a uterine recovery time of ≤ 4weeks, and 29 patients (93.5%) had resumption of menstruation of less than 6weeks. Three patients (9.7%) had complications. One of them suffered from massive vaginal bleeding and underwent s blood transfusion. There were no other complications, such as pelvic infection and uterine rupture during the procedures. And no patient was converted to surgical resection or uterine artery embolization. Overall, 30 patients (96.8%) were treated successfully. Local intra-gestational sac methotrexate injection followed by D&C with the aid of a Foley's balloon catheter compression appears to be a safe and effective treatment for CSP. Further randomized controlled trials are suggested to confirm these findings.