title: The efficacy of the systemic methotrexate treatment in caesarean scar ectopic pregnancy: A quantitative review of English literature.
abstract: To determine the efficacy and safety of primary medical treatment with systemic methotrexate (MTX) in caesarean scar ectopic pregnancy, we conducted a Medline/PubMed search on the relevant English literature from January 1978 to January 2012. The search yielded 27 publications of 40 cases of caesarean scar ectopic pregnancy. The literature search showed a very liberal use of systemic MTX treatment with unfavourable outcomes, although the major determinant of the clinical efficacy was found in here to be β-hCG level together with embryonic cardiac activity (ECA) status. A caesarean scar ectopic pregnancy presented with a serum β-hCG concentration of ≤ 12,000 mIU/ml (odds ratio, OR 5.68, 95% confidence interval, CI, 1.37-23.48) and absence of ECA (OR 4.80, 95% CI, 1.14-20.08) was found to be associated with higher efficacy rate of primary systemic MTX treatment. Administration of primary systemic MTX treatment was found to be ideal for a caesarean scar ectopic pregnancy presented before 8 weeks' gestation, with a β-hCG concentration of ≤ 12,000 mIU/ml together with an absent ECA (OR 14.52, 95% CI, 2.36-89.09).
authors.affiliation: Department of Obstetrics and Gynecology, GATA Medical Faculty , Ankara , Turkey.
authors.forename: S
authors.initials: S
authors.lastname: Bodur
authors.forename: Ö
authors.initials: Ö
authors.lastname: Özdamar
authors.forename: S
authors.initials: S
authors.lastname: Kılıç
authors.forename: I
authors.initials: I
authors.lastname: Gün
mesh_terms: D000019:Abortifacient Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000097:blood; D002921:Cicatrix / Q000150:complications*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008727:Methotrexate / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000019:Abortifacient Agents; D018997:Chorionic Gonadotropin, beta Subunit, Human; D008727:Methotrexate
keywords: Caesarean scar ectopic pregnancy; methotrexate; prognostic factors