The effects of methotrexate and uterine arterial embolization in patients with cesarean scar pregnancy: A retrospective case-control study

Abstract

In this study, we explored the optimal treatment for cesarean scar pregnancy (CSP). One hundred three women diagnosed with CSP received 1 of the 3 treatments: local or systemic methotrexate (MTX) injection and surgery (MTX + Surg), uterine arterial embolization (UAE) and surgery (UAE + Surg) or surgery only (Surg only). We compared their therapeutic effects and their follow-up results. There was no significant difference between the groups in the baseline of clinical characteristic except for the initial β human chorionic gonadotropin levels, which was highest in the MTX + Surg group (median, [interquartile range]), (120,004 [16,720-181,727] mIU/mL), compared to the UAE + Surg group (38,219 [23,194-100,029] mIU/mL) and Surg only group (22,557 [9113-49,573] mIU/mL). There was no significant difference between groups in the sonographic characteristic of patients. The intraoperative hemorrhage was highest in the Surg-only group (7/42, 16.67%), compared to the MTX + Surg group (4/26, 15.38%) and the UAE + Surg group (0/35, 0%). The incidence of intrauterine adhesions was highest in the UAE + Surg group (20%), compared to the MTX + Surg group (0%) and the Surg only group (0%). The incidence of embryo residue was highest in Surg-only group (21.43%), compared to the MTX + Surg group (0%) and the UAE + Surg group (2.86%). To conclude, MTX injection plus surgery might be the best treatment for CSP patients.

Figure 1

Cesarean scar pregnancy was differentiated into 3 types. As the status of scar defects varies greatly, the implantation may develop either into a normally shaped gestational sac with the basal decidua inserting into the scar (superficial type, Figure1.1), into a deformed sac half-embedded (partial type, Figure1.2), or totally embedded (complete type, Figure1.3) in the myometrium. Color Doppler shows increased blood flow surrounding the gestation sac.

Figure 1

Cesarean scar pregnancy was differentiated into 3 types. As the status of scar defects varies greatly, the implantation may develop either into a normally shaped gestational sac with the basal decidua inserting into the scar (superficial type, Figure1.1), into a deformed sac half-embedded (partial type, Figure1.2), or totally embedded (complete type, Figure1.3) in the myometrium. Color Doppler shows increased blood flow surrounding the gestation sac.

Figure 1

Cesarean scar pregnancy was differentiated into 3 types. As the status of scar defects varies greatly, the implantation may develop either into a normally shaped gestational sac with the basal decidua inserting into the scar (superficial type, Figure1.1), into a deformed sac half-embedded (partial type, Figure1.2), or totally embedded (complete type, Figure1.3) in the myometrium. Color Doppler shows increased blood flow surrounding the gestation sac.