Most Cesarean Scar Pregnancies Can be Managed with a Single Dose of Methotrexate

Abstract

Study Objective To investigate the effectiveness of single dose methotrexate (MTX) regimen in cases of cesarean scar pregnancy (CSP). Design A retrospective cohort study of all CSPs from a tertiary medical center between the years 2011-2019. Conservative management included treatment with systemic MTX with ultrasound (US) guided needle aspiration of the gestational sac in the presence of fetal heartbeat. We divided the cohort into two groups: women that were treated according to the conservative protocol, and women treated with additional curettage or hysteroscopy. Maternal and gestational characteristics were compared between the groups. Setting N/A Patients or Participants The final study cohort included 32 women diagnosed with CSP and treated according to the conservative protocol. Interventions N/A Measurements and Main Results 16(47.1%) women underwent additional US guided needle aspiration. Nineteen patients(59.4%) had a successful conservative treatment. Baseline maternal characteristics were similar in both groups. There was no difference between the two groups in the time from last cesarean delivery(25 month vs 32, respectively, p=0.31), gestational age(47 vs 49 days respectively, p=0.63), gestational sac size(23 vs. 21 mm, respectively, p=0.54), level of βHCG at presentation(17049 vs. 18612, respectively, p=0.77), or evidence of fetal heart beat(48% vs. 54%, respectively, p=0.71). The presence of gestational sac hematoma upon admission was identified as a negative predictive factor for successful conservative management(5.3% vs 38.5%,OR [95%CI] 11.2, (1.1-112.5),p=0.02). Conclusion Single dose MTX is an effective mode of treatment in cases of CSP. The presence of a gestational sac hematoma on US was identified as a negative predictor for successful conservative treatment of CSP. No other predictive factors were identified. To investigate the effectiveness of single dose methotrexate (MTX) regimen in cases of cesarean scar pregnancy (CSP). A retrospective cohort study of all CSPs from a tertiary medical center between the years 2011-2019. Conservative management included treatment with systemic MTX with ultrasound (US) guided needle aspiration of the gestational sac in the presence of fetal heartbeat. We divided the cohort into two groups: women that were treated according to the conservative protocol, and women treated with additional curettage or hysteroscopy. Maternal and gestational characteristics were compared between the groups. N/A The final study cohort included 32 women diagnosed with CSP and treated according to the conservative protocol. N/A 16(47.1%) women underwent additional US guided needle aspiration. Nineteen patients(59.4%) had a successful conservative treatment. Baseline maternal characteristics were similar in both groups. There was no difference between the two groups in the time from last cesarean delivery(25 month vs 32, respectively, p=0.31), gestational age(47 vs 49 days respectively, p=0.63), gestational sac size(23 vs. 21 mm, respectively, p=0.54), level of βHCG at presentation(17049 vs. 18612, respectively, p=0.77), or evidence of fetal heart beat(48% vs. 54%, respectively, p=0.71). The presence of gestational sac hematoma upon admission was identified as a negative predictive factor for successful conservative management(5.3% vs 38.5%,OR [95%CI] 11.2, (1.1-112.5),p=0.02). Single dose MTX is an effective mode of treatment in cases of CSP. The presence of a gestational sac hematoma on US was identified as a negative predictor for successful conservative treatment of CSP. No other predictive factors were identified.