Ugurkan Erkayiran, Tufan Arslanca, Jan Bozkurt

A retrospective comparison of systemic and local methotrexate therapy applied before uterine curettage in caesarean scar pregnancy

This study aimed to evaluate the results of patients who were treated with different treatment modalities due to cesarean scar pregnancy in terms of treatment success, development of complications, and additional treatment need. Patients underwent dilatation-curettage (D/C) only group 1 (n=22), systemic methotrexate was applied on the first and fourth day and D/C was applied on the seventh day, group 2 (n=27) and those who received intracavitary methotrexate on the first day and D/C on the seventh-day group 3 (n=33) to be divided into three groups. The demographic information of the patients, length of stay, response to treatment, complication rates, and whether there was any difference in factors associated with the development of complications were compared between the groups. When the patients were evaluated, it was seen that those in group 2 had a lower gestational week (p=0.011). In addition, it was observed that the patients in group 2 had a significantly longer hospital stay (p0.05). In our study, we observed that the possibility of complication development among the three methods was less in patients who underwent intracavitary methotrexate, but we could not statistically determine that this situation was significant. We also found that the use of systemic methotrexate is the most disadvantageous method in terms of both the length of stay and the development of complications.

PDF

___

Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: Pathogenic mechanisms and management strategies. Reprod Biol Endocrinol. 2015;13-30.
Pędraszewski P, Wlaźlak E, Panek W, et al. Cesarean scar pregnancy - a new challenge for obstetricians. J Ultrason. 2018;18:56-62.
Chiang AJ, La V, Chou CP, et al. Ectopic pregnancy in a cesarean section scar. Fertil Steril. 2011; 95: 2388–9.
Miller R, Timor-Tritsch IE, Gyamfi-Bannerman C. Cesarean scar pregnancy Am J Obstet Gynecol. 2020;222: B2-B14.
Kim YR, Moon MJ. Ultrasound-guided local injection of methotrexate and systemic intramuscular methotrexate in the treatment of cesarean scar pregnancy. Obstet Gynecol Sci. 2018;61:147-53.
Peng P, Gui T, Liu X, et al. Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Ther Clin Risk Manag. 2015;11:137-42.
Wang S, Beejadhursing R, Ma X, et al. Management of Caesarean scar pregnancy with or without methotrexate before curettage: human chorionic gonadotropin trends and patient outcomes. BMC Pregnancy Childbirth. 2018;18:289.
Fei H, Jiang X, Li T, et al. Comparison of three different treatment methods for cesarean scar pregnancy. Ther Clin Risk Manag. 2019;27;15:1377-81.
Birch Petersen K, Hoffmann E, Rifbjerg Larsen C, et al. Cesarean scar pregnancy: A systematic review of treatment studies. Fertil Steril. 2016;105:958–67.
Maheux-Lacroix S, Li F, Bujold E, et al. Cesarean scar pregnancies: A systematic review of treatment options. J Minim Invasive Gynecol. 2017;24:915–25.
Orhan A, Kasapoglu I, Cetinkaya DB, et al. Different treatment modalities and outcomes in cesarean scar pregnancy: A retrospective analysis of 31 cases in a unıversity hospital. Ginekol Pol. 2019;90:291-307.
Polat I, Ekiz A, Acar DK, et al. Suction curettage as first line treatment in cases with cesarean scar pregnancy: Feasibility and effectiveness in early pregnancy. J Matern Fetal Neonatal Med. 2016;29:1066-71.
Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy: Issues in management. Ultrasound Obstet Gynecol .2004;23;247–53.
Stika CS. Methotrexate: The pharmacology behind medical treatment for ectopic pregnancy. Clin Obstet Gynecol. 2012;55:433-9.
Tan KL, Jiang L, Chen YM, et al. Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy. Arch Gynecol Obstet. 2020;302:439-45.