Local intra-gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnanc
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GENERAL GYNECOLOGY
Local intra‑gestational sac methotrexate injection followed by dilation and curettage in treating cesarean scar pregnancy Kai‑Liang Tan1 · Li Jiang1 · Yu‑Mei Chen1 · Ying Meng1 · Bang‑Quan Lv1 · Liu‑Fei Wei1 · Xiao‑Zhu Peng1 · Yu‑Ying Ling1 · Jing Lan1 · Jin‑Ying Wei1 Received: 26 December 2019 / Accepted: 26 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Cesarean scar pregnancy · Intra-gestational sac · Local injection · Dilation and curettage · Methotrexate
Introduction Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy implanted in the scar tissue of a previous cesarean section, with an incidence ranging from 1 in 1800 up to 2216 [1, 2]. CSP may lead to life-threatening complications such as uterine rupture, massive bleeding, hysterectomy and cessation of fertility [1–3]. An early diagnosis is essential for ongoing conservative management and maintenance of fertility [4, 5]. * Kai‑Liang Tan [email protected] 1
Department of Obstetrics and Gynecology, Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, Nanning 530003, China
Several treatments for CSP have been reported recently, including systemic or
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