Experience in medical treatment of ectopic pregnancy, cesarean scar with three comparative methods: Methotrexate intra-gestational-sac injection, ultrasound-guided KCL injection, and hysteroscopy-assisted resection.

INTRODUCTION: Cesarean scar pregnancy (CSP) presents significant risks to the mother, and there is no consensus on the optimal treatment for this condition. This study was conducted to compare the effectiveness of three interventions: methotrexate (MTX) intra-gestational sac injection, potassium chloride (KCL) intra-gestational sac injection under ultrasound guidance, and hysteroscopic resection.

METHODS: Women with CSP were enrolled and randomly assigned to three groups: (1) MTX injection with curettage, (2) KCl injection with curettage, and (3) hysteroscopic resection performed one day after intramuscular MTX administration. Discharge was scheduled for the following day, provided there were no complications. Weekly follow-up assessments included measuring serum β-human chorionic gonadotropin (β-hCG) levels.

RESULTS: No statistically significant differences were observed in serum β-hCG levels among the groups before treatment or after intervention (p-value=0.396 and p-value=0.095, respectively). The length of hospitalization did not differ significantly between the groups (p = 0.903). Similarly, the time to β-hCG normalization showed no significant variation (p = 0.426). All three treatment strategies effectively achieved complete resolution, with a marked decline in serum β-hCG levels across all participants.

CONCLUSION: The comparative analysis indicates equivalent efficacy among the three interventions in terms of gestational sac resolution and β-hCG clearance time. No cases of uterine perforation, hemorrhage, hysterectomy, or extended hospitalization were reported following any of the treatments.