Evaluation of treatment of previous cesarean scar pregnancy with methotrexate: a systematic review and meta-analysis

Abstract

Background: Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP.

Method: This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I² index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2.

Results: In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7-93.5%), and complication was 9% (95% CI: 6.3-12.8%).

Conclusion: The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.

Keywords: CSP; Caesarean scar pregnancy; MTX; Meta-analysis; Methotrexate.

Fig. 1

Flow diagram of study selection

Fig. 2

Funnel plot of results related to Intraoperative blood loss (ml)

Fig. 3

Funnel plot of results related to Hospital stay (days)

Fig. 4

Funnel plot of results related to Time for serum-hCG snormalisation (days)

Fig. 5

Funnel plot of results related to percentage of success

Fig. 6

Funnel plot of results related to percentage of complication

Fig. 7

mean level of β-hCG before the intervention and confidence interval of 95%. The middle point of each line shows mean level of β-hCG before the intervention in each study, and the rhombic figure shows mean level of β-hCG before intervention for all the studies

Fig. 8

Mean level of β-hCG after the intervention and confidence interval of 95%. The middle point of each line shows mean level of β-hCG before the intervention in each study, and the rhombic figure shows mean level of β-hCG before intervention for all the studies

Fig. 9

Mean Intraoperative blood loss (ml) and confidence interval of 95%. The middle point of each line shows mean Intraoperative blood loss (ml) in each study, and the rhombic figure shows mean Intraoperative blood loss (ml) for all the studies

Fig. 10

Mean Hospital stay (days) and confidence interval of 95%. The middle point of each line shows mean Hospital stay (days) in each study, and the rhombic figure shows mean Hospital stay (days) for all the studies

Fig. 11

Time for serum-hCG snormalisation (days) and confidence interval of 95%. The middle point of each line shows Time for serum-hCG snormalisation (days) in each study, and the rhombic figure shows Time for serum-hCG snormalisation (days) for all the studies

Fig. 12

Success and confidence interval of 95%. The middle point of each line shows Success in each study, and the rhombic figure shows Success for all the studies

Fig. 13

Complication and confidence interval of 95%. The middle point of each line shows Complication in each study, and the rhombic figure shows Complication for all the studies