Is methotrexate administration needed for the treatment of caesarean section scar pregnancy in addition to suction curettage?
OBJECTIVE
This study evaluated the clinical outcomes and safety of treating caesarean scar pregnancy (CSP) by means of suction curettage followed when required by Foley tamponade, with or without methotrexate (MTX) therapy preceding the curettage.


METHODS
Twenty-five patients with CSP were identified between August 2008 and April 2012. The first team of doctors treated Group A patients (n = 11) with systemic MTX followed by dilatation and suction curettage whereas the second team of doctors carried out only a suction curettage on women of Group B (n = 14). If uncontrolled vaginal bleeding occurred in either group during or after the operation, a Foley catheter, guided by real time transabdominal ultrasound, was placed in the uterine cavity against the site where the CSP had been implanted.


RESULTS
Clinical outcomes in the two groups - including mean estimated blood loss, major complication rate, and hospital length of stay - were comparable. Surgeons used Foley catheter balloons for tamponade in six of the 11 patients in Group A and in seven of the 14 patients in Group B. Treatment was successful in ten of 11 cases in group A and 13 of 14 cases in group B. Group B's mean duration of treatment (2.36 ± 0.49 days) was significantly shorter than that of Group A (14.45 ± 4.96 days; p < 0.001).


CONCLUSIONS
Suction curettage, followed when needed by Foley catheter tamponade, is an effective treatment for CSP.
* Department of Obstetrics and Gynaecology, Suleymaniye Maternity Hospital for Research and Training.
Osman
O
Sevket
Seda
S
Keskin
Seda
S
Ates
Taner
T
Molla
Ramazan
R
Dansuk
Hasan Fehmi
HF
Yazicioglu
Oguz
O
Yucel
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000601:surgery*; D010064:Embryo Implantation; D005260:Female; D006801:Humans; D007902:Length of Stay; D008727:Methotrexate / Q000008:administration & dosage* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014546:Urinary Catheterization; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000628:therapy; D014619:Vacuum Curettage / Q000379:methods*
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate