Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: single-center experience.

Abstract

The aim of this study was to investigate the efficacy, and the safety of systemic multidose methotrexate (MTX) for the treatment of cesarean scar pregnancy (CSP). This retrospective cohort study was performed using records from the Department of Obstetrics and Gynecology, Erciyes University, between 2010 and 2012. The data were analyzed with respect to obstetric characteristic, course of treatment, clinical, and reproductive outcomes. A total of 13 patients were evaluated. The median gestational age at diagnosis was 5 weeks 5 days (range: 4-9 weeks). The mean beta human chorionic gonadotrophin level was 11,240.31 ± 9812.68 IU/L (range: 2565-36,111 IU/L). All patients were successfully treated with systemic multidose MTX therapy. The average MTX dose was 5.7 (range: 2-9). The interval between the first MTX injection and the normalization of beta human chorionic gonadotrophin was 8 ± 2.27 weeks (range: 4-12 weeks). One patient showed mild leucopenia that reversed after the treatment. Three patients had successful uncomplicated intrauterine pregnancy after the treatment, which resulted in term infants. 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.