title: Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy: efficacy and subsequent fecundity.
abstract: OBJECTIVE
  To investigate the efficacy of local methotrexate (MTX) injections under transvaginal ultrasound guidance for treatment of cesarean scar pregnancy (CSP) and to assess fecundity after treatment.
  
  
  METHODS
  Retrospective review (Canadian Task Force classification II-3).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Eight women with CSP.
  
  
  METHODS
  Transvaginal MTX injection.
  
  
  RESULTS
  We retrospectively reviewed 8 CSP cases treated with local MTX injection under transvaginal ultrasonographic guidance. In all cases, the serum human chorionic gonadotropin concentration was monitored and the gestational sac was evaluated using ultrasonography after treatment. Magnetic resonance imaging was performed as necessary. Patient clinical characteristics, clinical course after treatment, treatment efficacy, and fecundity after treatment in patients desiring subsequent pregnancies were evaluated. All 8 women were successfully treated without the need for blood transfusions or surgical procedures, although 2 required additional MTX therapy via local injection or systemic administration. The mean (SD) time to human chorionic gonadotropin normalization was 78.5 (37.7) days (range, 42-166 days). Four of 5 patients desiring subsequent pregnancies after the treatment had uneventful parturition, and recurrent CSP was diagnosed in 1 patient.
  
  
  CONCLUSIONS
  Transvaginal MTX injection was effective and safe as sole treatment of CSP. Although the treatment course tended to be long, this method can be considered the first choice of treatment in patients desiring future pregnancies. However, careful attention should be paid to the possibility of CSP recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan. Electronic address: munekage@hotmail.co.jp.
authors.forename: Munekage
authors.initials: M
authors.lastname: Yamaguchi
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan.
authors.forename: Ritsuo
authors.initials: R
authors.lastname: Honda
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan.
authors.forename: Kikuko
authors.initials: K
authors.lastname: Uchino
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Tashiro
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohba
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Life Sciences, Kumamoto University, Kumamoto City, Kumamoto 860-8556, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Katabuchi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000282:Administration, Intravaginal; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D006063:Chorionic Gonadotropin; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: Cesarean scar pregnancy; Fecundity; Human chorionic gonadotropin; MTX; Transvaginal methotrexate injection