Local and Systemic Methotrexate Administration Along With Hysteroscopic Treatment of Cesarean Scar Pregnancy

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2025-06-03 DOI:10.1016/j.jogc.2025.102925

Magdalena Piróg MD, PhD , Jagoda Sarad MD , Dominik Skoczylas MD , Olga Kacalska-Janssen MD, PhD , Robert Jach MD, PhD

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引用次数: 0

Abstract

Objective

To evaluate treatment outcomes of local and systemic methotrexate (MTX) treatment followed by hysteroscopic removal of the residual gestational mass in women with cesarean scar pregnancy (CSP).

Methods

We studied 43 women with CSP between December 2021 and May 2024. We measured treatment outcomes, including changes in β-human chorionic gonadotropin (β-hCG) levels after MTX administration, along with duration to achieve undetectable β-hCG levels and treatment-related complications.

Results

We have enrolled women at a median age of 35.2 ± 4.1 years and a BMI of 25.4 ± 5.3 kg/m². The median gestational age at diagnosis was 8.0 (7.2–9.0) weeks, with a mean gestational sac size of 20.5 ± 4.3 mm and positive fetal cardiac activity in 61.8% (n = 21) women. After a mean time of 49.7 ± 4.8 days, a hysteroscopy was performed. Overall, 41 women (95.3%) were successfully treated and achieved an undetectable β-hCG level, and 2 women had an urgent hysterectomy related to the hemorrhage.

Conclusions

In types II and III of CSP, implementing a combination of local and systemic MTX administration followed by hysteroscopic removal of residual gestational mass is a safe, well-tolerated, and fertility-preserving treatment method.

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局部及全身甲氨蝶呤配合宫腔镜治疗剖宫产瘢痕妊娠。

目的：评价局部和全身甲氨蝶呤（MTX）治疗后宫腔镜下切除瘢痕妊娠（CSP）的治疗效果。方法：我们在2021年12月至2024年5月期间研究了43名患有CSP的女性。我们测量了治疗结果，包括服用MTX后ß-hCG水平的变化，以及达到无法检测到的ß-hCG水平的持续时间和治疗相关并发症。结果：我们纳入的女性中位年龄为35.2±4.1岁，BMI为25.4±5.3 kg/m2。诊断时的中位胎龄为8.0[7.2-9.0]周，平均胎囊大小为20.5±4.3 mm, 61.8% （n=21）的女性胎儿心脏活动呈阳性。平均时间49.7±4.8 d后行宫腔镜检查。41名妇女（95.3%）成功治疗并达到无法检测到的ß-hCG水平，2名妇女因出血而紧急切除子宫。结论：在II型和III型CSP中，局部和全身联合使用甲氨蝶呤并宫腔镜切除残余妊娠团块是一种安全、耐受性良好且保留生育能力的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.