Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols

Uludağ, Semih; Kütük, Mehmet Serdar; Ak, Mehmet; Özgün, Mahmut Tuncay; Dolanbay, Mehmet; Aygen, Ercan; Şahin, Yılmaz

doi:10.1016/j.ejogrb.2016.09.010

Cited by 33 publications

(22 citation statements)

References 31 publications

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“…The most common side effect seen with systemic methotrexate treatment was oral ulcers seen in 26% (7/27) patients which responded to local treatment in a retrospective cohort of CSP treated with either local or systemic methotrexate 11. In another systematic review, side effects seen in various studies with methotrexate treatment were elevated liver enzymes (2%), suppression of bone marrow (2%), fever (1%) and oral ulcers (1%) 12.…”

Section: Discussionmentioning

confidence: 99%

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Gupta

Kriplani

Mahey³

et al. 2017

BMJ Case Reports

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Two cases of live caesarean scar ectopic pregnancies are presented. Beta human chorionic gonadotropin (b-hCG) values in both patients at presentation were 50 099 mIU and 297 969 mIU, respectively. Both were managed with intrasac potassium chloride injection to induce fetal demise and multiple dose methotrexate therapy. The time for b-hCG to become negative in both patients was 91 days and 119 days, respectively. Successful management of live caesarean scar pregnancies even with very high b-hCG is possible with minimally invasive approach.

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Section: Discussionmentioning

confidence: 99%

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Gupta

Kriplani

Mahey³

et al. 2017

BMJ Case Reports

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“…A total of 358 articles were identified; 122 were assessed with respect to their eligibility for inclusion and 44 studies were included in the systematic review (Table 1, Figure 1). 9,10,21‐61 These studies included 3598 women with a prior CSP; of these, information on subsequent pregnancy was available for 592 women.…”

Section: Resultsmentioning

confidence: 99%

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Morlando

Buca

Timor‐Tritsch

et al. 2020

Acta Obstet Gynecol Scand

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Introduction To evaluate subsequent reproductive among women with a prior cesarean scar pregnancy (CSP). Material and methods MEDLINE, Embase and ClinicalTrials.gov databases were searched. Inclusion criteria were women with a prior CSP, defined as the gestational sac or trophoblast within the dehiscence/niche of the previous cesarean section scar or implanted on top of it. The primary outcome was the recurrence of CSP; secondary outcomes were the chance of achieving a pregnancy after CSP, miscarriage, preterm birth, uterine rupture and the occurrence of placenta accreta spectrum disorders. Subgroup analysis according to the management of CSP (surgical vs non‐surgical) was also performed. Random effect meta‐analyses of proportions were used to analyze the data. Results Forty‐four studies (3598 women with CSP) were included. CSP recurred in 17.6% of women. Miscarriage, preterm birth and placenta accreta spectrum disorders complicated 19.1% (65/341), 10.3% (25/243) and 4.0% of pregnancies, and 67.0% were uncomplicated. When stratifying the analysis according to the type of management, CSP recurred in 21% of women undergoing surgical and in 15.2% of those undergoing non‐surgical management. Placenta accreta spectrum disorders complicated 4.0% and 12.0% of cases, respectively. Conclusions Women with a prior CSP are at high risk of recurrence, miscarriage, preterm birth and placenta accreta spectrum. There is still insufficient evidence to elucidate whether the type of management adopted (surgical vs non‐surgical) can impact reproductive outcome after CSP. Further large, prospective studies sharing an objective protocol of prenatal management and long‐term follow up are needed to establish the optimal management of CSP and to elucidate whether it may affect its risk of recurrence and pregnancy outcome in subsequent gestations.

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“…Currently, many conservative strategies have been established, including systemic and/or local MTX, D&C, hysteroscopy, laparoscopy, transvaginal resection, UAE, high-intensity focused ultrasound, and combined treatment [10,[18][19][20][21]. Among these, systemic and local MTX are the most widely used forms of management for CSP due to their minimally invasive nature [22]. MTX is a dihydrofolate reductase inhibitor used in the treatment of autoimmune diseases, malignancy, and as an abortifacient [1].…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of cesarean scar pregnancy with transvaginal injection of absolute ethanol around the gestation sac via ultrasound

Liu

Tang

2019

BMC Pregnancy Childbirth

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Comparison of systemic and local methotrexate treatments in cesarean scar pregnancies: time to change conventional treatment and follow-up protocols

Abstract: Even though treatment success and reproductive outcomes are similar, local methotrexate is superior to systemic methotrexate with regard to recovery time, side effects, and treatment costs, even in patients with unfavorable pretreatment prognostic predictors.

Cited by 33 publications

References 31 publications

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Successful management of caesarean scar live ectopic pregnancies with local KCL and systemic methotrexate

Reproductive outcome after cesarean scar pregnancy: A systematic review and meta‐analysis

Successful treatment of cesarean scar pregnancy with transvaginal injection of absolute ethanol around the gestation sac via ultrasound

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