title: Transvaginal ultrasound-guided local methotrexate administration as the first-line treatment for cesarean scar pregnancy: Follow-up of 18 cases.
abstract: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, which occurs in previous cesarean section scar tissue, with an incidence of 1 in 1800-3000 pregnancies. Transvaginal ultrasound-guided local methotrexate (MTX) administration presents as a non-systemic option with possible better penetration to the pregnancy site. We present the management of 18 patients with CSP solely by transvaginal ultrasound-guided local MTX administration. All patients were treated with local MTX with a dose of 50 mg/m(2) . Eleven (61.1%) of the patients did not need any further intervention. Four patients (22.2%) were treated with additional single-dose systemic MTX due to inadequate alteration in blood β-human chorionic gonadotrophin levels. Three patients (16.7%) required hysteroscopy and/or laparotomy. We suggest that transvaginal ultrasound-guided local MTX treatment may be considered as a first-line treatment for CSP.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Baskent University, Ankara, Turkey.
authors.forename: Tayfun
authors.initials: T
authors.lastname: Cok
authors.forename: Hakan
authors.initials: H
authors.lastname: Kalayci
authors.forename: Halis
authors.initials: H
authors.lastname: Ozdemir
authors.forename: Bulent
authors.initials: B
authors.lastname: Haydardedeoglu
authors.forename: Ayse H
authors.initials: AH
authors.lastname: Parlakgumus
authors.forename: Ebru
authors.initials: E
authors.lastname: Tarim
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate
keywords: cesarean scar pregnancy; ectopic pregnancy; local; methotrexate; ultrasound-guided