title: Conservative management of cesarean scar pregnancies: a prospective randomized controlled trial at a single center.
abstract: OBJECTIVE
  To assess clinical outcomes related to conservative management of women with cesarean scar pregnancies (CSPs), specifically through uterine artery embolization (UAE) with local and systemic methotrexate (MTX) treatment (UAE-MTX), or ultrasound-guided local and systemic MTX treatment (USG-MTX).
  
  
  METHODS
  Forty-five patients with CSP were randomly allocated to receive UAE-MTX (n = 24) or USG-MTX (n = 21). Participants' clinical outcomes were compared, and clinical characteristics of failed cases were evaluated relative to successful cases.
  
  
  RESULTS
  The 2 groups were similar in clinical characteristics, success rate (83.3% cf. 80.9%), time to normalization of serum beta (β) human chorionic gonadotropin (β-hCG), and percentage of patients receiving multiple doses of systemic MTX. However, within the failed cases, the percentages of patients with gestational sac > 5 cm (87.5%), or type II CSP (75.0%) was significantly higher than in the successful cases (13.5% and 18.9%, respectively; P < 0.001, both), without regard to treatment group. According to the logistic regression model, a gestational sac diameter > 5 cm or type II CSP were independent risk factors for failed CSP management (gestational sac > 5 cm: OR 51.87, 95% CI 3.48-775.91, P < 0.01; type II CSP: OR 15.54, 95% CI 1.25-193.36, P < 0.05).
  
  
  CONCLUSIONS
  The conservative treatments UAE-MTX and USG-MTX were similarly effective in treating CSP patients. Either treatment was likely to fail for CSP patients with gestational sac > 5 cm or type II CSP.
authors.affiliation: Department of Obstetrics and Gynecology, General Hospital of The People's Liberation Army Chengdu Military Region, People's Republic of China.
authors.forename: Mingyi
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, General Hospital of The People's Liberation Army Chengdu Military Region, People's Republic of China.
authors.forename: Zhiling
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Quality Management, General Hospital of the People's Liberation Army Chengdu Military Region, People's Republic of China.
authors.forename: Yunming
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University Xi'an, Shaanxi, People's Republic of China.
authors.forename: Biliang
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University Xi'an, Shaanxi, People's Republic of China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University Xi'an, Shaanxi, People's Republic of China.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Obstetrics and Gynecology, General Hospital of The People's Liberation Army Chengdu Military Region, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
keywords: Cesarean scar pregnancy; conservative management; methotrexate; ultrasound; uterine artery embolization