Ultrasound-guided local methotrexate treatment for cesarean scar pregnancy in the first trimester: 12 years of single-center experience in China

Abstract

ObjectiveTo investigate the efficacy and safety of ultrasound-guided local injection of methotrexate (MTX) in the treatment of cesarean scar pregnancy (CSP) diagnosed in the first trimester. Study designThe clinical and imaging data of 101 CSP patients who received ultrasound-guided local injection of MTX in our hospital between January 2007 and December 2018 were retrospectively analyzed. The decline in serum β human chorionic gonadotropin (βHCG) level, size and blood flow of lesions, vaginal bleeding, liver/kidney functions, and other indicators were observed or tested after treatment on a weekly basis. ResultsThe duration of amenorrhea was 6.1 ± 0.8 weeks (range: 5.7–8.1 weeks) and the initial serum βHCG level was 20,321 ± 965 U/L in 97 patients, The mean time t to βHCG normalization was 40 ± 14 days (range: 21–140 days), Minor intermittent vaginal bleeding occurred after local MTX injection, lasting 25 ± 17 days (range: 10–61 days), and the lesions at the scar sites had completely disappeared with an average interval of 39 ± 29 days ; The treatment failed in four patients. The average duration of amenorrhea was 7.5 weeks and the average initial serum βHCG level was 91,359 U/L. ConclusionUltrasound-guided local injection of MTX is an effective and minimally invasive treatment for CSP. However, it is not feasible for patients with long-term amenorrhea (>8 weeks) and markedly increased blood βHCG level.