The Effectiveness of Letrozole Adjunct in the Combined Pharmacological and Surgical Treatment of Cesarean Scar Pregnancy: A Prospective Cohort Study.

OBJECTIVES

To compare the treatment outcomes of cesarean scar pregnancy (CSP) using a combined pharmacological and surgical approach with and without adjunct letrozole.

METHODS

All women received 100 mg of methotrexate intravenously and 50 mg intra-amniotically. The intervention group also received 5 mg of letrozole orally for 10 days. After decreased CSP viability, hysteroscopic evacuation of trophoblastic remnants was performed. Biochemical indicators of efficacy and complications of pharmacotherapy, time interval to surgery, intraoperative blood loss, complications, and subsequent obstetric outcomes were compared across both study arms.

RESULTS

Among 28 women, 16 received letrozole, whereas 12 received only methotrexate. There were no significant differences in serum β-human chorionic gonadotropin (β-hCG), hemoglobin, renal and liver parameters on days 0, 4, and 7 or in intraoperative blood loss, decrease in postoperative hemoglobin, red blood cell concentrate units transfused, uterine tamponade, complications, or obstetric outcomes. The day 0 β-hCG concentration correlated positively with postoperative hemoglobin reduction (P = 0.007), blood loss (P < 0.001), red blood cell concentrate units transfused (P = 0.012), and risk of uterine perforation or hemorrhage (P = 0.043). Cases with a positive fetal heartbeat experienced significantly greater blood loss (P = 0.019) and a higher number of red blood cell concentrate units transfused (P = 0.033).

CONCLUSIONS

The incorporation of letrozole in the studied regimen did not impact the final end points. The significant factors influencing intraoperative blood loss and complications were the initial concentration of β-hCG and the presence of a fetal heartbeat. Combined treatment of CSP with methotrexate, followed by hysteroscopy, is a safe method that ensures effective treatment while preserving the uterus.