title: Local Methotrexate Injection as the First-line Treatment for Cesarean Scar Pregnancy: Review of the Literature.
abstract: The objective of this study was to determine the outcome of using ultrasound-guided local methotrexate injection as the first-line treatment of cesarean scar pregnancy (CSP). A literature review was performed on all eligible reports using this modality as the first-line treatment of CSP. Relevant publications were obtained from the PubMed electronic database from inception to December 2014. Ninety-six cases from 95 women reported in 17 articles were reviewed. The success rate was 73.9% after a single local methotrexate injection. An accumulated success rate of 88.5% could be achieved after additional local or intramuscular methotrexate administration. Eleven cases (11.5%) failed methotrexate treatment and required surgical interventions. Except for women with serum human chorionic gonadotropin levels higher than 100 000 IU/L, ultrasound-guided local methotrexate injection could be considered as a first-line treatment modality for CSP.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong, Hong Kong. Electronic address: vytc@hku.hk.
authors.forename: Vincent Y T
authors.initials: VY
authors.lastname: Cheung
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000282:Administration, Intravaginal; D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D006063:Chorionic Gonadotropin / Q000378:metabolism; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: Cesarean scar pregnancy; Ectopic pregnancy; Local injection; Methotrexate; Ultrasound-guided