Skip to main content

Advertisement

SpringerLink
Log in

Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the safety and efficacy of local intra-gestational sac methotrexate injection followed by dilation and curettage (D&C) in treating cesarean scar pregnancies (CSP).

Method

Medical records of CSP patients treated with local intra-gestational sac methotrexate injection followed by dilation and curettage were analyzed at the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China.

Results

Thirty-one patients were included in this study. The mean gestational age, sac diameter and thickness of the uterine scar were 49.6 ± 7.7 days, 1.8 ± 0.6 cm and 0.30 ± 0.15 cm, respectively. The median pretreatment serum β-human chorionic gonadotropin (β-HCG) level was 40,887 mIU/mL, with the 25th and 75th percentiles at 19,852 and 74,552, respectively. The median blood loss during D&C was 20 mL with the 25th and 75th percentiles at 10 mL and 50 mL. Following D&C, a Foley’s balloon catheter compression was implanted in 26 (83.9%) patients due to active uterine bleeding. All patients had a β-HCG regression time of ≤ 4 weeks after D&C. While 30 patients (96.8%) had a uterine recovery time of ≤ 4 weeks, and 29 patients (93.5%) had resumption of menstruation of less than 6 weeks. Three patients (9.7%) had complications. One of them suffered from massive vaginal bleeding and underwent s blood transfusion. There were no other complications, such as pelvic infection and uterine rupture during the procedures. And no patient was converted to surgical resection or uterine artery embolization. Overall, 30 patients (96.8%) were treated successfully.

Conclusion

Local intra-gestational sac methotrexate injection followed by D&C with the aid of a Foley’s balloon catheter compression appears to be a safe and effective treatment for CSP. Further randomized controlled trials are suggested to confirm these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL (2004) Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol 23(3):247–253

    Article  PubMed  Google Scholar 

  2. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ (2003) First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar. Ultrasound Obstet Gynecol 21(3):220–227

    Article  CAS  PubMed  Google Scholar 

  3. Nonaka M, Toyoki H, Imai A (2006) Cesarean section scar pregnancy may be the cause of serious hemorrhage after first-trimester abortion by dilatation and curettage. Int J Gynaecol Obstet 95(1):50–51

    Article  CAS  PubMed  Google Scholar 

  4. Vial Y, Petignat P, Hohlfeld P (2000) Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol 16(6):592–593

    Article  CAS  PubMed  Google Scholar 

  5. Nukaga S, Aoki S, Kurasawa K, Takahashi T, Hirahara F (2014) A case of misdiagnosed cesarean scar pregnancy with a viable birth at 28 weeks. Case Rep Obstet Gynecol 2014:375685

    PubMed  PubMed Central  Google Scholar 

  6. An X, Ming X, Li K, Wang J (2013) The analysis of efficacy and failure factors of uterine artery methotrexate infusion and embolization in treatment of cesarean scar pregnancy. ScientificWorldJournal 2013:213603

    Article  PubMed  PubMed Central  Google Scholar 

  7. Peng P, Gui T, Liu X, Chen W, Liu Z (2015) Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy. Ther Clin Risk Manag 11:137–142

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Chen YQ, Liu HS, Li WX, Deng C, Hu XW, Kuang PJ (2015) Efficacy of transvaginal debridement and repair surgery for cesarean scar pregnancy: a cohort study compared with uterine artery embolism. Int J Clin Exp Med 8(11):21187–21193

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Wu XQ, Zhang HW, Fang XL, Ding H, Piao L, Joseph Huang S (2015) Factors associated with successful transabdominal sonography-guided dilation and curettage for early cesarean scar pregnancy. Int J Gynaecol Obstet 131(3):281–284

    Article  PubMed  Google Scholar 

  10. Yin XH, Yang SZ, Wang ZQ, Jia HY, Shi M (2014) Injection of MTX for the treatment of cesarean scar pregnancy: comparison between different methods. Int J Clin Exp Med 7(7):1867–1872

    PubMed  PubMed Central  Google Scholar 

  11. Hudeček R, Felsingerová Z, Felsinger M, Jandakova E (2014) Laparoscopic treatment of cesarean scar ectopic pregnancy. J Gynecol Surg 30(5):309–311

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sun YY, Xi XW, Yan Q, Qiao QQ, Feng YJ, Zhu YP (2015) Management of type II unruptured cesarean scar pregnancy: comparison of gestational mass excision and uterine artery embolization combined with methotrexate. Taiwan J Obstet Gynecol 54(5):489–492

    Article  PubMed  Google Scholar 

  13. Ficicioglu C, Attar R, Yildirim G, Cetinkaya N (2010) Fertility preserving surgical management of methotrexate-resistant cesarean scar pregnancy. Taiwan J Obstet Gynecol 49(2):211–213

    Article  PubMed  Google Scholar 

  14. Li N, Zhu F, Fu S, Shi X (2012) Transvaginal ultrasound-guided embryo aspiration plus local administration of low-dose methotrexate for caesarean scar pregnancy. Ultrasound Med Biol 38(2):209–213

    Article  PubMed  Google Scholar 

  15. Wang M, Yang Z, Li Y, Chen B, Wang J, Ma X, Wang Y (2015) Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center. Int J Clin Exp Med 8(10):18972–18980

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Polat I, Alkis I, Sahbaz A, Sahin O, Ekiz A, Gulac B, Tekirdag AI (2012) Diagnosis and management of cesarean scar pregnancy. Clin Exp Obstet Gynecol 39(3):365–368

    CAS  PubMed  Google Scholar 

  17. Wang DB, Chen YH, Zhang ZF, Chen P, Liu KR, Li Y, Fu L (2014) Evaluation of the transvaginal resection of low-segment cesarean scar ectopic pregnancies. Fertil Steril 101(2):602–606

    Article  PubMed  Google Scholar 

  18. Hofmann HM, Urdl W, Höfler H, Hönigl W, Tamussino K (1987) Cervical pregnancy: case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet 241(1):63–69

    Article  CAS  PubMed  Google Scholar 

  19. Kung FT, Lin H, Hsu TY, Chang CY, Huang HW, Huang LY, Chou YJ, Huang KH (2004) Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 81(6):1642–1649

    Article  PubMed  Google Scholar 

  20. Zhang H, Shi J, Yang Y, Liang Y, Gao X, Wang J, Liu H, Wu B, Zhao J (2015) Transvaginal surgical management of cesarean scar pregnancy II (CSP-II): an analysis of 25 cases. Med Sci Monit 21:3320–3326

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cok T, Kalayci H, Ozdemir H, Haydardedeoglu B, Parlakgumus AH, Tarim E (2015) Transvaginal ultrasound-guided local methotrexate administration as the first-line treatment for cesarean scar pregnancy: follow-up of 18 cases. J Obstet Gynaecol Res 41(5):803–808

    Article  CAS  PubMed  Google Scholar 

  22. Maheux-Lacroix S, Li F, Bujold E, Nesbitt-Hawes E, Deans R, Abbott J (2017) Cesarean scar pregnancies: a systematic review of treatment options. J Minim Invasive Gynecol 24(6):915–925

    Article  PubMed  Google Scholar 

  23. Wang CN, Chen CK, Wang HS, Chiueh HY, Soong YK (2007) Successful management of heterotopic cesarean scar pregnancy combined with intrauterine pregnancy after in vitro fertilization-embryo transfer. Fertil Steril 88(3):706.e13–16

    Article  Google Scholar 

  24. Timor-Tritsch IE, Cali G, Monteagudo A, Khatib N, Berg RE, Forlani F, Avizova E (2015) Foley balloon catheter to prevent or manage bleeding during treatment for cervical and cesarean scar pregnancy. Ultrasound Obstet Gynecol 46(1):118–123

    Article  CAS  PubMed  Google Scholar 

  25. Kanat-Pektas M, Bodur S, Dundar O, Bakır VL (2016) Systematic review: what is the best first-line approach for cesarean section ectopic pregnancy. Taiwan J Obstet Gynecol 55(2):263–269

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the Guangxi Health Commission Department research program (Grant No: Z20170769), for which the authors are grateful. We would also like to thank the editor and reviewers for their valuable insights and assistance.

Funding

This study was funded by the Guangxi Health Commission Department research program (Grant number: Z20170769).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, China

    Kai-Liang Tan, Li Jiang, Yu-Mei Chen, Ying Meng, Bang-Quan Lv, Liu-Fei Wei, Xiao-Zhu Peng, Yu-Ying Ling, Jing Lan & Jin-Ying Wei

Authors
  1. Kai-Liang Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Li Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yu-Mei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ying Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bang-Quan Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Liu-Fei Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiao-Zhu Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yu-Ying Ling
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jing Lan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jin-Ying Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Kai-Liang Tan: Protocol development, Manuscript writing and editing, Li Jiang: Protocol development, Yu-Mei Chen: Data collection, Ying Meng: Data collection, Bang-Quan Lv: Data management, Liu-Fei Wei: Data collection, Xiao-Zhu Peng: Data analysis, Yu-Ying Ling: Data collection, Jing Lan: Data collection, Jin-Ying Wei: Data analysis, All authors contributed to the study conception and design. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kai-Liang Tan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committee of Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China. (Reference number: (2019) 9–1).

Informed consent

Informed consent were obtained before patients received treatments.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tan, KL., Jiang, L., Chen, YM. et al. Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy. Arch Gynecol Obstet 302, 439–445 (2020). https://doi.org/10.1007/s00404-020-05619-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-020-05619-x

Keywords

Search

Navigation