European journal of obstetrics, gynecology, and reproductive biology · 2024
Local and systemic methotrexate in management of caesarean scar pregnancy.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Toutain Typhaine, Capmas Perrine, Fernandez Hervé, Couet Déborah, Pourcelot Anne-Gaëlle, Debras Elodie
Аннотация
STUDY OBJECTIVE: The aim is to analyze the management of cesarean scar pregnancy (CSP) based on local and systemic Methotrexate, a protocol implemented in a referral center.
DESIGN: This is an observational, retrospective, monocentric, cohort study with a description of the local protocol, treatment results and tolerance profile. Design Classification III.
SETTING: Tertiary Referral center.
PATIENTS: All patients with CSP, confirmed by a reference ultrasound, without severity criteria requiring emergency surgery, between March 2015 to August 2022 were consecutively included.
INTERVENTIONS: All patients were treated by an Echo-guided trans-vaginal aspiration of the gestational sac followed by a local injection of Methotrexate 1 mg/kg under general anesthesia combined with Mifepristone and followed by an injection of 1 mg/kg within 2 days.
MEASUREMENT AND MAIN FINDING: We included 35 patients with a mean hCG level of 28 872 UI/l ± 38063 UI/l and a mean gestational age of 6.8 ± 1.6 weeks of gestation. All patients were managed effectively with a good reduction in hCG serum levels. The mean duration of hCG negativation was 66 ± 38 days after the start of management. Only one patient who had received the department's Methotrexate protocol required a second line of treatment. Among major complications, 2 patients experienced hemorrhagic shock which resolved without recourse to hemostasis hysterectomy. The success rate defined by the absence of recourse to secondary treatment was therefore 91.4 %. Among minor complications, the main complication was methotrexate-induced hepatic cytolysis in 7 patients (20 %). Nine women (26 %) required secondary hysteroscopic resection of trophoblastic retention. Twenty-one patients (60 %) had an ultrasound diagnosis of caesarean scar defect (CSD) after CSP management.
CONCLUSION: The combination of transvaginal ultrasound-guided local MTX, Mifepristone and systemic MTX appears to be an effective treatment protocol for patients with CSP.
DESIGN: This is an observational, retrospective, monocentric, cohort study with a description of the local protocol, treatment results and tolerance profile. Design Classification III.
SETTING: Tertiary Referral center.
PATIENTS: All patients with CSP, confirmed by a reference ultrasound, without severity criteria requiring emergency surgery, between March 2015 to August 2022 were consecutively included.
INTERVENTIONS: All patients were treated by an Echo-guided trans-vaginal aspiration of the gestational sac followed by a local injection of Methotrexate 1 mg/kg under general anesthesia combined with Mifepristone and followed by an injection of 1 mg/kg within 2 days.
MEASUREMENT AND MAIN FINDING: We included 35 patients with a mean hCG level of 28 872 UI/l ± 38063 UI/l and a mean gestational age of 6.8 ± 1.6 weeks of gestation. All patients were managed effectively with a good reduction in hCG serum levels. The mean duration of hCG negativation was 66 ± 38 days after the start of management. Only one patient who had received the department's Methotrexate protocol required a second line of treatment. Among major complications, 2 patients experienced hemorrhagic shock which resolved without recourse to hemostasis hysterectomy. The success rate defined by the absence of recourse to secondary treatment was therefore 91.4 %. Among minor complications, the main complication was methotrexate-induced hepatic cytolysis in 7 patients (20 %). Nine women (26 %) required secondary hysteroscopic resection of trophoblastic retention. Twenty-one patients (60 %) had an ultrasound diagnosis of caesarean scar defect (CSD) after CSP management.
CONCLUSION: The combination of transvaginal ultrasound-guided local MTX, Mifepristone and systemic MTX appears to be an effective treatment protocol for patients with CSP.