Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes

Sheng Wang,Rajluxmee Beejadhursing,Xiangyi Ma,Ya Li

doi:10.1186/s12884-018-1923-x

Sheng Wang, Rajluxmee Beejadhursing + Show 2 more

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https://doi.org/10.1186/s12884-018-1923-x

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Abstract

BackgroundTo evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage.MethodsA retrospective review of all women presenting with CSP treated with ultrasound-guided suction curettage at Tongji Hospital, Wuhan, China, between January 1, 2013 and December 31, 2015, was conducted. Patients were grouped into those not treated with methotrexate before curettage (group 1), treated with methotrexate by intramuscular injection (group 2) and treated with methotrexate by intravenous injection (group 3). The clinical characteristics and outcomes were analyzed.ResultsAmong 107 patients, 47 patients were not treated with methotrexate before curettage, 46 patients had methotrexate administered by intramuscular injection and 14 patients had methotrexate injected intravenously. There were no significant differences among the groups in basic and clinical characteristics, such as age, gravity, parity, positive fetal heart beat and gestational age at diagnosis. Patients presented similar initial human chorionic gonadotropin (hCG) levels in all groups. After treatment with methotrexate or curettage, the percentage changes and varied ranges of the hCG levels were also similar in all groups. There were no significant differences in intraoperative blood loss and retained products of conception among the three groups. However group 1 had significantly shorter hospital stays than the two groups that were treated with methotrexate (p<0.001).ConclusionBy grouping CSP patients who shared similar age, gravity, parity, fetal heart beat positive and gestational age at diagnosis, we found that the presence or absence of methotrexate treatment before curettage resulted in comparable outcomes and hCG levels, although patients who were not treated with methotrexate had significantly shorter stays in the hospital.

Highlights

To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage
While the optimal management of CSP remains unclear, there is a variety of therapeutic strategies are currently in use, such as medical treatment with systemic MTX, medical treatment with systemic and local MTX, uterine curettage, hysteroscopy, resection of CSP through a transvaginal approach, uterine artery embolization, laparoscopy, and high-intensity focused ultrasound [2]
The aim of this study was to evaluate the human chorionic gonadotropin (hCG) levels and outcomes in CSP patients treated with or without MTX before curettage to assess the efficacy of MTX

Summary

Introduction

To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage. CSP is a special type ectopic pregnancy and as such, some researchers have investigated the use of MTX in conservative management or preliminary treatment of CSP prior to curettage [6, 7]. Semih Z. reported that systemic MTX manifested similar results compared to local MTX in terms of treatment success and reproductive outcomes [8]. Some researchers have further suggested that systemic MTX may be less effective in cases with higher serum hCG concentrations [9].

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