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CC BY-NC-ND 4.0 · Ultrasound Int Open 2023; 09(01): E18-E25
DOI: 10.1055/a-2137-8318
Original Article

Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided Methotrexate Injection Seems to be a Safe Option for Treatment

Angeliki Rouvalis
1   Obstetrics and Gynecology, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Panagiotis Vlastarakos 
1   Obstetrics and Gynecology, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Georgios Daskalakis
1   Obstetrics and Gynecology, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Abraham Pouliakis
2   2nd Department of Pathology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
,
Sofoklis Stavrou
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Maria Tsiriva
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Maria Giourga 
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Angeliki Gerede
4   Department of Obstetrics and Gynecology, Democritus University of Thrace, Alexandroupolis, Greece
,
Kalliopi Pappa
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Themos Gregoriadis
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Dimitrios-Efthymios Vlachos
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Alexandros Rodolakis
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
,
Ekaterini Domali
3   First Department of Obstetrics and Gynecology, University of Athens, Greece, National and Kapodistrian University of Athens – 1st Obstetrics and Gynecology Clinic, Athens, Greece
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Abstract

Objective

The purpose of the study was to assess the efficacy of local ultrasound-guided methotrexate injection in patients with caesarean section scar pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG) after treatment, and to see if HCG levels are correlated with clinical presentation.

Methods

Between May 2018 and January 2021, data were collected retrospectively from the Early Pregnancy Unit of a tertiary hospital.

Results

Our clinic assessed 20 patients; one disputed terminating the pregnancy and was not included in the research. The remaining 19 patients, with a median age of 34 years, received intragestational sac methotrexate injection under ultrasound guidance. 7w3d was the median gestational age. These women had one to four previous caesarean sections, with a mean of 1.60±9. Patients with caesarean scar pregnancy most typically presented with spotting (42.1%), whereas 26.3% were asymptomatic. Except in cases of pain, the symptomatic women’s HCG levels were lower than in the non-symptomatic women. The level of HCG in patients with pain was approximately double that of non-pain patients (p=0.2557). In our series, intragestational sac methotrexate injection was effective in 17/19 women, or 89.5% (95%CI: 75.7-100%). HCG levels were undetectable in 97.6±30 days on average (minimum: 42 days, maximum: 147 days).

Conclusion

Caesarean scar pregnancy is a rare possibly fatal condition with no consensus on the optimal treatment. An experienced Early Pregnancy Unit member performing local methotrexate injections under ultrasound guidance is a feasible and successful strategy in clinically stable patients.

Key words

ectopic pregnancy - cesarean scar pregnancy - transvaginal ultrasound - methotrexate - gynecology


Publication History

Received: 04 October 2022

Accepted: 15 March 2023

Article published online:
18 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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