title: Uterine artery embolization combined with local methotrexate and systemic methotrexate for treatment of cesarean scar pregnancy with different ultrasonographic pattern.
abstract: OBJECTIVE
  This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients.
  
  
  METHODS
  The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m(2) body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum β-hCG were monitored during follow-up. Data were analyzed with the Student's t test.
  
  
  RESULTS
  Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy.
  
  
  CONCLUSIONS
  For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.
authors.affiliation: Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Sun Yat-sen University, No. 58, Zhongshan 2nd Road, Guangzhou 510080, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Lian
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Jiaping
authors.initials: J
authors.lastname: Li
authors.forename: Zhongping
authors.initials: Z
authors.lastname: Zhan
authors.forename: Yujin
authors.initials: Y
authors.lastname: Ye
authors.forename: Yunxiao
authors.initials: Y
authors.lastname: Zhu
authors.forename: Jia
authors.initials: J
authors.lastname: Huang
authors.forename: Hanshi
authors.initials: H
authors.lastname: Xu
authors.forename: Xiuyan
authors.initials: X
authors.lastname: Yang
authors.forename: Liuqin
authors.initials: L
authors.lastname: Liang
authors.forename: Jianyong
authors.initials: J
authors.lastname: Yang
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002921:Cicatrix / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D014463:Ultrasonography; D055357:Uterine Artery Embolization / Q000379:methods*; D014599:Uterus / Q000000981:diagnostic imaging*
chemical_list: D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate