Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study

Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CS...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Giancarlo Garuti [verfasserIn] Paola Francesca Sagrada [verfasserIn] Lorenzo Sogaro [verfasserIn] Serena Migliaccio [verfasserIn] Marilena Farella [verfasserIn] Marco Soligo [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy

Übergeordnetes Werk:	In: Clinical and Experimental Obstetrics & Gynecology - IMR Press, 2022, 50(2023), 3, p 67
Übergeordnetes Werk:	volume:50 ; year:2023 ; number:3, p 67

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.31083/j.ceog5003067

Katalog-ID:	DOAJ087608529

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520			\|a Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration.
650		4	\|a cesarean scar pregnancy
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allfields	10.31083/j.ceog5003067 doi (DE-627)DOAJ087608529 (DE-599)DOAJf576a35239b343b5aba4e19d7938b48e DE-627 ger DE-627 rakwb eng RG1-991 Giancarlo Garuti verfasserin aut Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration. cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy Gynecology and obstetrics Paola Francesca Sagrada verfasserin aut Lorenzo Sogaro verfasserin aut Serena Migliaccio verfasserin aut Marilena Farella verfasserin aut Marco Soligo verfasserin aut In Clinical and Experimental Obstetrics & Gynecology IMR Press, 2022 50(2023), 3, p 67 (DE-627)731337824 (DE-600)2693497-8 27090094 nnns volume:50 year:2023 number:3, p 67 https://doi.org/10.31083/j.ceog5003067 kostenfrei https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e kostenfrei https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 kostenfrei https://doaj.org/toc/0390-6663 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 50 2023 3, p 67
spelling	10.31083/j.ceog5003067 doi (DE-627)DOAJ087608529 (DE-599)DOAJf576a35239b343b5aba4e19d7938b48e DE-627 ger DE-627 rakwb eng RG1-991 Giancarlo Garuti verfasserin aut Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration. cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy Gynecology and obstetrics Paola Francesca Sagrada verfasserin aut Lorenzo Sogaro verfasserin aut Serena Migliaccio verfasserin aut Marilena Farella verfasserin aut Marco Soligo verfasserin aut In Clinical and Experimental Obstetrics & Gynecology IMR Press, 2022 50(2023), 3, p 67 (DE-627)731337824 (DE-600)2693497-8 27090094 nnns volume:50 year:2023 number:3, p 67 https://doi.org/10.31083/j.ceog5003067 kostenfrei https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e kostenfrei https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 kostenfrei https://doaj.org/toc/0390-6663 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 50 2023 3, p 67
allfields_unstemmed	10.31083/j.ceog5003067 doi (DE-627)DOAJ087608529 (DE-599)DOAJf576a35239b343b5aba4e19d7938b48e DE-627 ger DE-627 rakwb eng RG1-991 Giancarlo Garuti verfasserin aut Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration. cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy Gynecology and obstetrics Paola Francesca Sagrada verfasserin aut Lorenzo Sogaro verfasserin aut Serena Migliaccio verfasserin aut Marilena Farella verfasserin aut Marco Soligo verfasserin aut In Clinical and Experimental Obstetrics & Gynecology IMR Press, 2022 50(2023), 3, p 67 (DE-627)731337824 (DE-600)2693497-8 27090094 nnns volume:50 year:2023 number:3, p 67 https://doi.org/10.31083/j.ceog5003067 kostenfrei https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e kostenfrei https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 kostenfrei https://doaj.org/toc/0390-6663 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 50 2023 3, p 67
allfieldsGer	10.31083/j.ceog5003067 doi (DE-627)DOAJ087608529 (DE-599)DOAJf576a35239b343b5aba4e19d7938b48e DE-627 ger DE-627 rakwb eng RG1-991 Giancarlo Garuti verfasserin aut Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration. cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy Gynecology and obstetrics Paola Francesca Sagrada verfasserin aut Lorenzo Sogaro verfasserin aut Serena Migliaccio verfasserin aut Marilena Farella verfasserin aut Marco Soligo verfasserin aut In Clinical and Experimental Obstetrics & Gynecology IMR Press, 2022 50(2023), 3, p 67 (DE-627)731337824 (DE-600)2693497-8 27090094 nnns volume:50 year:2023 number:3, p 67 https://doi.org/10.31083/j.ceog5003067 kostenfrei https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e kostenfrei https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 kostenfrei https://doaj.org/toc/0390-6663 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 50 2023 3, p 67
allfieldsSound	10.31083/j.ceog5003067 doi (DE-627)DOAJ087608529 (DE-599)DOAJf576a35239b343b5aba4e19d7938b48e DE-627 ger DE-627 rakwb eng RG1-991 Giancarlo Garuti verfasserin aut Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration. cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy Gynecology and obstetrics Paola Francesca Sagrada verfasserin aut Lorenzo Sogaro verfasserin aut Serena Migliaccio verfasserin aut Marilena Farella verfasserin aut Marco Soligo verfasserin aut In Clinical and Experimental Obstetrics & Gynecology IMR Press, 2022 50(2023), 3, p 67 (DE-627)731337824 (DE-600)2693497-8 27090094 nnns volume:50 year:2023 number:3, p 67 https://doi.org/10.31083/j.ceog5003067 kostenfrei https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e kostenfrei https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 kostenfrei https://doaj.org/toc/0390-6663 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 50 2023 3, p 67
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Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). 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callnumber-first	R - Medicine
author	Giancarlo Garuti
spellingShingle	Giancarlo Garuti misc RG1-991 misc cesarean scar pregnancy misc ectopic pregnancy misc hysteroscopy misc methotrexate misc outpatient hysteroscopy misc Gynecology and obstetrics Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study
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topic_title	RG1-991 Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study cesarean scar pregnancy ectopic pregnancy hysteroscopy methotrexate outpatient hysteroscopy
topic	misc RG1-991 misc cesarean scar pregnancy misc ectopic pregnancy misc hysteroscopy misc methotrexate misc outpatient hysteroscopy misc Gynecology and obstetrics
topic_unstemmed	misc RG1-991 misc cesarean scar pregnancy misc ectopic pregnancy misc hysteroscopy misc methotrexate misc outpatient hysteroscopy misc Gynecology and obstetrics
topic_browse	misc RG1-991 misc cesarean scar pregnancy misc ectopic pregnancy misc hysteroscopy misc methotrexate misc outpatient hysteroscopy misc Gynecology and obstetrics
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title	Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study
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title_sort	cesarean scar pregnancy treated by systemic or local methotrexate administration followed by hysteroscopic removal: a comparative pilot study
callnumber	RG1-991
title_auth	Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study
abstract	Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration.
abstractGer	Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration.
abstract_unstemmed	Background: Cesarean Scar Pregnancy (CSP) is a life-threatening condition following an ectopic implantation within the scar of a previous cesarean delivery and no guideline is shared about optimal treatment options. Methods: We present a retrospective study comparing the outcomes of patients with CSP diagnosed before the 10th week of gestation treated by systemic or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic placental removal. After MTX administration, the weekly decrease-rate of beta Human Chorionic Gonadotropin subunit (β-HCG) was adopted as criterion to indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to surgery timing (50% decline in two consecutive assessments). Results: Fourteen patients satisfied the inclusion criteria. Eight and six of them underwent systemic (group A) and local (group B) MTX administration, respectively. No significant difference was found in pre-treatment and intra-operative variables. Group B showed significantly accelerated times in weekly halving of β-HCG with respect to group A (p-value = 0.005). Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. Local MTX allows quicker trophoblastic demise, leading to significant anticipation of surgery with respect to systemic administration.
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title_short	Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study
url	https://doi.org/10.31083/j.ceog5003067 https://doaj.org/article/f576a35239b343b5aba4e19d7938b48e https://www.imrpress.com/journal/CEOG/50/3/10.31083/j.ceog5003067 https://doaj.org/toc/0390-6663
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up_date	2024-07-04T02:21:24.564Z
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Accordingly, the elapsing time between MTX and surgery was found to be significantly longer in the group A than in the group B (p-value = 0.016). In group B no patient required further MTX administration whereas 3 out of 8 patients from group A required an additional MTX dose. In all patients hysteroscopic surgery resulted uneventful and no further treatment was required. Conclusions: When followed by hysteroscopic placental removal, systemic or local MTX administration resulted effective to treat CSP. 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Cesarean Scar Pregnancy Treated by Systemic or Local Methotrexate Administration Followed by Hysteroscopic Removal: A Comparative Pilot Study

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