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. 2015 Oct 15;8(10):18972-80.
eCollection 2015.

Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center

Mingyi Wang  1 , Zhiling Yang  1 , Yunming Li  2 , Biliang Chen  3 , Jian Wang  3 , Xiangdong Ma  3 , Yu Wang  1
Affiliations

Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center

Mingyi Wang et al. Int J Clin Exp Med. .

Abstract

Purpose: To assess clinical outcomes related to conservative management of women with cesarean scar pregnancies (CSPs), specifically through uterine artery embolization (UAE) with local and systemic methotrexate (MTX) treatment (UAE-MTX), or ultrasound-guided local and systemic MTX treatment (USG-MTX).

Methods: Forty-five patients with CSP were randomly allocated to receive UAE-MTX (n = 24) or USG-MTX (n = 21). Participants' clinical outcomes were compared, and clinical characteristics of failed cases were evaluated relative to successful cases.

Results: The 2 groups were similar in clinical characteristics, success rate (83.3% cf. 80.9%), time to normalization of serum beta (β) human chorionic gonadotropin (β-hCG), and percentage of patients receiving multiple doses of systemic MTX. However, within the failed cases, the percentages of patients with gestational sac > 5 cm (87.5%), or type II CSP (75.0%) was significantly higher than in the successful cases (13.5% and 18.9%, respectively; P < 0.001, both), without regard to treatment group. According to the logistic regression model, a gestational sac diameter > 5 cm or type II CSP were independent risk factors for failed CSP management (gestational sac > 5 cm: OR 51.87, 95% CI 3.48-775.91, P < 0.01; type II CSP: OR 15.54, 95% CI 1.25-193.36, P < 0.05).

Conclusion: The conservative treatments UAE-MTX and USG-MTX were similarly effective in treating CSP patients. Either treatment was likely to fail for CSP patients with gestational sac > 5 cm or type II CSP.

Keywords: Cesarean scar pregnancy; conservative management; methotrexate; ultrasound; uterine artery embolization.

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Figure 1
Figure 1
Flow chart of enrollment of participants in this study.
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