Other treatments for CSP

Knapman, Blake L.; Forgues, Miss Anne-Sophie; Abbott, Jason A.; Maheux-Lacroix, Sarah

doi:10.1016/j.bpobgyn.2023.102367

Cited by 3 publications

(1 citation statement)

References 61 publications

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“…5,8 The management strategy of a CSP may differ individually. Expectant management, medical treatment, various surgical approaches, or a combination of these may be taken into consideration 9 . Nevertheless, there are few standardized guidelines for CSP management.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonography Findings in Post-Methotrexate Treatment of Cesarean Scar Pregnancy

Eghbali,

Karbasi,

Sodabi

et al. 2024

Int J Drug Res Clin

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Background: Cesarean scar pregnancy (CSP) can cause life-threatening complications for pregnant women, so early diagnosis and treatment are crucial for the prevention of maternal mortality. Transvaginal color Doppler ultrasonography, along with serum beta-human chorionic gonadotropin (β-hCG) level follow-up, can be a noninvasive and proper method for the post-treatment follow-up of a CSP. The present study investigated the Doppler resistance index (RI) changes in CSPs after medical management with methotrexate (MTX), evaluated by sac diameter and serum β-hCG level measurement. Methods: Overall, 28 patients with CSP and a history of previous cesarean delivery, a gestational age of less than 9 completed weeks at ultrasonography, the decision to medical management by the gynecologist, and having a β-hCG level before treatment were enrolled and initially examined by ultrasound and Doppler studies. The RI of the closest myometrial artery to the CSP mass and its diameter underwent measurement. After 72 hours, 1 week, and 2 weeks of medical therapy with MTX, the mentioned variables were measured again and compared with the values of the pretreatment time point. Results: RI values were significantly higher at all the follow-up time points compared with the pre-treatment time points, while serum β-hCG levels were significantly lower. Moreover, sac diameter values increased 72 hours post-treatment and then represented a decline. Conclusion: Serial Doppler ultrasound examination can be a useful method to evaluate the success or failure of the medical management of CSPs, as the increase in RI values occurs rapidly after medical treatment and correlates well with serum β-hCG levels.

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Section: Introductionmentioning

confidence: 99%

Ultrasonography Findings in Post-Methotrexate Treatment of Cesarean Scar Pregnancy

Eghbali,

Karbasi,

Sodabi

et al. 2024

Int J Drug Res Clin

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Conservative treatment of cesarean scar pregnancy with the combination of methotrexate and mifepristone: A systematic review

Stabile,

Vona,

Carlucci

et al. 2024

Womens Health (Lond Engl)

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Background: Cesarean scar pregnancy (CSP) has become more frequent as a direct consequence of the increased number of cesarean deliveries and the advances in imaging. Although some cases are characterized by spontaneous resolution, unrecognized or mishandled CSP has the potential to cause both fetal and maternal morbidity and mortality. However, due to its infrequency, there is no agreement on the best management. Objective: The purpose of this study was to evaluate the safety, the risks and effectiveness of medical therapy with methotrexate and mifepristone to better understand its role in CSP therapy. Design: This study is a systematic review. Data Sources and Methods: The electronic databases PubMed, Medline, and Scopus were comprehensively searched until December 2023. Medical Subject Headings terms (Cesarean scar pregnancy) AND (Methotrexate) AND (Mifepristone) AND (Medical Therapy) were used to identify the relevant records. Due to the rarity of this pathology, the studies included are all case reports or case series. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports. Results: We included in our review a total of seven cases reported in five manuscripts at the end of the screening process. Our review suggests that this type of combination treatment can be considered. The success rate is 71.4%. Treatment seems to be most effective when beta human chorionic gonadotropin (B-hCG) is below 5,000 mUi/ml and when the gestational sac is less than 20 mm. The absence of fetal heartbeat seems to be a positive prognostic factor for a positive outcome. Conclusion: Methotrexate and mifepristone administration can be considered as an alternative first-line effective treatment, especially in case of pregnancy with B-hCG <5,000 mUi/ml and when the gestational sac is less than 20 mm. It is important to individualize the management and treatment according to the clinical condition, the patient’s age, number of previous cesarean deliveries, willingness to have other children, and the physicians’ experience.

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Comprehensive diagnostic and therapeutic approaches to uterine teratoma in postmenopausal women: a case study and review

Pan,

Lan,

Tang

et al. 2024

Front. Oncol.

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Background and objectiveUterine teratomas are extremely rare in postmenopausal women and pose significant challenges in diagnosis and treatment. This study reports a case of a 54-year-old postmenopausal woman diagnosed with a uterine teratoma during a routine gynecological ultrasound. The study aims to explore the diagnosis and treatment of uterine teratomas in postmenopausal women through detailed imaging assessment and hysteroscopy surgery, aiming to enhance the understanding of this rare uterine tumor and improve patient treatment outcomes and quality of life.MethodsThis study utilized hysteroscopic surgery to excise a mass initially suspected to be a uterine fibroid and performed pathological analysis. The analysis revealed the presence of fat and hair, confirming the diagnosis of a mature benign uterine teratoma. Additionally, the study includes a literature review summarizing the clinical characteristics, diagnostic methods, and treatment strategies for uterine teratomas.ResultsHysteroscopic surgery effectively identified and removed the complex uterine teratoma. Pathological analysis confirmed the teratoma contained various mature tissues, including neural tissue, bone, and cartilage. Comparative analysis of imaging features with surgical outcomes helped propose more precise diagnostic criteria and treatment guidelines.ConclusionHysteroscopy surgery plays a crucial role in diagnosing uterine teratomas in postmenopausal women and showcases its advantages of minimal trauma and quick recovery in treatment. In addition, the literature review emphasizes the diagnostic challenges of uterine teratomas in clinical practice, particularly in expanding clinical awareness of the differences between premenopausal and postmenopausal presentations. It also summarizes the diagnostic and treatment strategies for rare uterine masses, contributing to the improved recognition of these rare cases.

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Other treatments for CSP

Cited by 3 publications

References 61 publications

Ultrasonography Findings in Post-Methotrexate Treatment of Cesarean Scar Pregnancy

Ultrasonography Findings in Post-Methotrexate Treatment of Cesarean Scar Pregnancy

Conservative treatment of cesarean scar pregnancy with the combination of methotrexate and mifepristone: A systematic review

Comprehensive diagnostic and therapeutic approaches to uterine teratoma in postmenopausal women: a case study and review

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