title: Successful medical treatment of cesarean scar ectopic pregnancies with systemic multidose methotrexate: single-center experience.
abstract: OBJECTIVE
  The aim of this study was to investigate the efficacy, and the safety of systemic multidose methotrexate (MTX) for the treatment of cesarean scar pregnancy (CSP).
  
  
  METHODS
  This retrospective cohort study was performed using records from the Department of Obstetrics and Gynecology, Erciyes University, between 2010 and 2012. The data were analyzed with respect to obstetric characteristic, course of treatment, clinical, and reproductive outcomes.
  
  
  RESULTS
  A total of 13 patients were evaluated. The median gestational age at diagnosis was 5 weeks 5 days (range: 4-9 weeks). The mean beta human chorionic gonadotrophin level was 11,240.31 ± 9812.68 IU/L (range: 2565-36,111 IU/L). All patients were successfully treated with systemic multidose MTX therapy. The average MTX dose was 5.7 (range: 2-9). The interval between the first MTX injection and the normalization of beta human chorionic gonadotrophin was 8 ± 2.27 weeks (range: 4-12 weeks). One patient showed mild leucopenia that reversed after the treatment. Three patients had successful uncomplicated intrauterine pregnancy after the treatment, which resulted in term infants.
  
  
  CONCLUSIONS
  Systemic multidose MTX therapy is an effective and safe treatment method for CSP. However, further studies are needed to compare the safety, effectiveness and reproductive outcome of different treatment modalities in CSP.
authors.affiliation: Department of Obstetrics and Gynecology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
authors.forename: Mehmet Serdar
authors.initials: MS
authors.lastname: Kutuk
authors.forename: Gulsum
authors.initials: G
authors.lastname: Uysal
authors.forename: Mehmet
authors.initials: M
authors.lastname: Dolanbay
authors.forename: Mahmut Tuncay
authors.initials: MT
authors.lastname: Ozgun
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000150:complications*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: cesarean scar pregnancy; ectopic pregnancy; methotrexate; scar ectopic; systemic