Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: efficacy and subsequent fecundity

• Published in: Journal of minimally invasive gynecology Vol. 21; no. 5; p. 877
• Main Authors: Yamaguchi, Munekage, Honda, Ritsuo, Uchino, Kikuko, Tashiro, Hironori, Ohba, Takashi, Katabuchi, Hidetaka
• Format: Journal Article
• Language: English
• Published: United States 01.09.2014
• Subjects: Abortifacient Agents, Nonsteroidal - administration & dosage; Abortifacient Agents, Nonsteroidal - therapeutic use; Administration, Intravaginal; Adult; Cesarean Section - adverse effects; Chorionic Gonadotropin; Cicatrix - diagnostic imaging; Cicatrix - pathology; Female; Fertility; Follow-Up Studies; Humans; Methotrexate - administration & dosage; Methotrexate - therapeutic use; Pregnancy; Pregnancy, Ectopic - diagnostic imaging; Pregnancy, Ectopic - drug therapy; Pregnancy, Ectopic - pathology; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional; MTX; Transvaginal methotrexate injection; Fecundity; Human chorionic gonadotropin; Cesarean scar pregnancy
• ISSN: 1553-4669
• DOI: 10.1016/j.jmig.2014.03.024

To investigate the efficacy of local methotrexate (MTX) injections under transvaginal ultrasound guidance for treatment of cesarean scar pregnancy (CSP) and to assess fecundity after treatment. Retrospective review (Canadian Task Force classification II-3). University hospital. Eight women with CSP. Transvaginal MTX injection. We retrospectively reviewed 8 CSP cases treated with local MTX injection under transvaginal ultrasonographic guidance. In all cases, the serum human chorionic gonadotropin concentration was monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging was performed as necessary. Patient clinical characteristics, clinical course after treatment, treatment efficacy, and fecundity after treatment in patients desiring subsequent pregnancies were evaluated. All 8 women were successfully treated without the need for blood transfusions or surgical procedures, although 2 required additional MTX therapy via local injection or systemic administration. The mean (SD) time to human chorionic gonadotropin normalization was 78.5 (37.7) days (range, 42-166 days). Four of 5 patients desiring subsequent pregnancies after the treatment had uneventful parturition, and recurrent CSP was diagnosed in 1 patient. Transvaginal MTX injection was effective and safe as sole treatment of CSP. Although the treatment course tended to be long, this method can be considered the first choice of treatment in patients desiring future pregnancies. However, careful attention should be paid to the possibility of CSP recurrence.