title: Successful Treatment of Caesarean Scar Pregnancies by Local Treatment Only.
abstract: Background. Caesarean scar pregnancy (CSP) is a rare ectopic pregnancy associated with life-threatening complications. To date, no therapeutic protocols have been established. Sono-guided local methotrexate (MTX) injection is a relatively easy and low-invasive treatment. Additional systemic MTX is sometimes needed for CSP cases, especially whenβ-subunit human chorionic gonadotropin (β-hCG) levels are >20,000 mIU/ml at diagnosis. We report on six cases of CSP treated with local MTX injection, five of which received combined local treatment.Methods. Under intravenous anesthesia, six CSPs including a case withβ-hCG levels >20,000 mIU/ml received MTX injection to the gestational sac. Five cases received gestational sac aspiration. Three cases had additional local potassium chloride injection and one case had a saline injection aiming at the fetal heart beat concurrent with MTX injection. MTX was administered weekly ifβ-hCG levels stayed beyond the expected values.Outcomes. All cases achievedβ-hCG normalization without additional systemic MTX, with one case having a successful pregnancy after treatment.Conclusion. Sono-guided local MTX injection with concurrent local treatment might be a potentially effective approach for CSP cases. The accumulation of further cases is necessary to confirm this.
authors.affiliation: Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Shinji
authors.identifier: 0000-0001-6914-5054
authors.initials: S
authors.lastname: Tanigaki
authors.affiliation: Department of Education for Clinical Research, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Nagata
authors.affiliation: Department of Obstetrics and Gynecology, Kawasaki Municipal Hospital, Kawasaki, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ueno
authors.affiliation: Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Ozawa
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nagaoka
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
authors.affiliation: Department of Obstetrics and Gynecology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwashita