Transvaginal Ultrasound-Guided Embryo Aspiration Plus Local Administration of Low-Dose Methotrexate for Caesarean Scar Pregnancy

Li, Na; Zhu, Fang; Fu, Shuxin; Shi, Xiaobo

doi:10.1016/j.ultrasmedbio.2011.10.012

Cited by 42 publications

(21 citation statements)

References 15 publications

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“…In that case, a 9‐week CSP patient was managed conservatively with local KCl and MTX injection under the guidance of transvaginal sonography. When compared with systemic MTX plus surgical intervention, local MTX administration was accepted to be equally effective regarding duration needed for β‐hCG normalization, genital infection and length of hospital stay and local MTX had lower occurrence rate of massive vaginal bleeding and elevated transaminase levels . However in that study, local MTX administration was followed by systemic MTX a week later regardless of β‐hCG level, which obscures the consequences of the local treatment alone.…”

Section: Discussionmentioning

confidence: 91%

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Çok

Kalaycı

Özdemir

et al. 2014

J of Obstet and Gynaecol

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Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, which occurs in previous cesarean section scar tissue, with an incidence of 1 in 1800–3000 pregnancies. Transvaginal ultrasound‐guided local methotrexate (MTX) administration presents as a non‐systemic option with possible better penetration to the pregnancy site. We present the management of 18 patients with CSP solely by transvaginal ultrasound‐guided local MTX administration. All patients were treated with local MTX with a dose of 50 mg/m2. Eleven (61.1%) of the patients did not need any further intervention. Four patients (22.2%) were treated with additional single‐dose systemic MTX due to inadequate alteration in blood β‐human chorionic gonadotrophin levels. Three patients (16.7%) required hysteroscopy and/or laparotomy. We suggest that transvaginal ultrasound‐guided local MTX treatment may be considered as a first‐line treatment for CSP.

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Section: Discussionmentioning

confidence: 91%

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Çok

Kalaycı

Özdemir

et al. 2014

J of Obstet and Gynaecol

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“…In these instances, hysterectomy may be a life saving measure. Additionally, ultrasound has been found to be a valuable tool in the management of CSP allowing the administration of embryocidal agents directly to the sac under sonographic guidance 45 . The use of local treatment is widely documented and has proven to be very safe and effective in appropriately selected patients, while also reducing the need for systemic therapy 46 , 47 .…”

Section: Treatmentmentioning

confidence: 99%

“…It has been proposed that a CSP may develop from the seeding of a blastocyst within scar defects. Several studies have demonstrated that these defects can be identified in the non‐pregnant state, using this method 45 . TV ultrasound has been found to be up to 100% sensitive and specific for detecting caesarean scars defects with the use of saline sonohysterography 58 – 60 .…”

Section: Treatmentmentioning

confidence: 99%

Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound

Collins¹,

Kothari

2015

Australas J Ultrason Med

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Ectopic pregnancy that implants within the scar tissue of a previous caesarean scar is a situation that is seldom encountered and is almost invariably incompatible with a successful pregnancy. Caesarean scar ectopic pregnancies are fraught with life threatening complications such as scar rupture, significant haemorrhage, disseminated intravascular coagulation and the need for emergency life saving hysterectomy. The clinical diagnosis can be elusive, particularly in the early stages; therefore clinicians should be familiar with the condition's sonographic hallmarks. Early diagnosis and management is the key to preventing these complications. We describe a case of caesarean scar pregnancy which was initially misdiagnosed as “a spontaneous miscarriage in progress”, resulting in uncontrollable bleeding, necessitating an emergency abdominal hysterectomy. We also endeavour to review the literature with regards to the use of ultrasound in its management, treatment and follow up.

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“…[9][10][11] Apart from a slight reduction in blood loss, systemic methotrexate, methotrexate uterine artery injection/ embolisation and excision by laparotomy have been found to be comparable.…”

Section: Discussionmentioning

confidence: 97%

Conventional laparotomy for management of caesarean scar ectopic pregnancy: a case report

Mhaske

Jhaveri

Prasad

et al. 2015

Int J Reprod Contracept Obstet Gynecol

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Transvaginal Ultrasound-Guided Embryo Aspiration Plus Local Administration of Low-Dose Methotrexate for Caesarean Scar Pregnancy

Cited by 42 publications

References 15 publications

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Transvaginal ultrasound‐guided local methotrexate administration as the first‐line treatment for cesarean scar pregnancy: Follow‐up of 18 cases

Catastrophic consequences of a caesarean scar pregnancy missed on ultrasound

Conventional laparotomy for management of caesarean scar ectopic pregnancy: a case report

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