Methotrexate therapy for cesarean section scar pregnancy with and without suction curettage.

OBJECTIVE

To compare the clinical effects in women with cesarean scar pregnancy (CSP) who were treated with either methotrexate (MTX) regimen only or MTX regimen followed by dilation and curettage (D&C).

DESIGN

Prospective consecutive clinical cohort study.

SETTING

University hospital for obstetrics, gynecology, and reproductive medicine.

SUBJECT(S): Seventy-one cases of CSP.

INTERVENTION(S): The subjects were treated with either MTX only (MTX group, 21 cases) or MTX followed by D&C (combined therapy group, 50 cases).

MAIN OUTCOME MEASURE(S): Success rates, hysterectomy rates, and time to resolution of serum beta-hCG and the CSP mass were compared between the two groups.

RESULT(S): Compared with the MTX group, the combined therapy group had a shorter time to resolution of the CSP mass and serum beta-hCG. There was no significant difference between the MTX and combined therapy groups regarding success rates (76.2% vs. 90.0%, respectively) and hysterectomy rates (19.0% vs. 8.0%, respectively).

CONCLUSION(S): Both therapies could treat the majority of CSP patients successfully, but the combined therapy resulted in a shorter time of therapy and indicated a more favorable effect.