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Abstract
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Introduction: Cesarean scar pregnancy (CSP) is a rare complication involving the implantation of an embryo in the location of a prior hysterotomy scar. The incidence of CSP is correlated with increasing cesarean delivery rates. Our objective was to evaluate the effectiveness of different treatment modalities for CSP at a single tertiary care institution and formulate an optimal treatment plan.
Methods: Retrospective chart review of CSP cases at INOVA Fairfax Hospital between 2012-2019 was conducted. The BhCG levels were trended to determine the rate of decline following treatment. Five treatment modalities were identified: (i) intra-gestational sac methotrexate (IS-MTX) alone; (ii) intramuscular MTX alone (IM-MTX); (iii) IM-MTX with IS-MTX; (iv) IM-MTX with subsequent IS-MTX; and (v) IM-MTX with uterine artery embolization (UAE). Treatment success was defined arbitrarily by BhCG decline to 5% of baseline by week 5 of treatment.
Results: Among 647 ectopic pregnancies treated during the study period, 17 CSP were identified of which 10 cases met inclusion criteria and were used for analyses. All groups differed in the rate of decline of BhCG levels (p = 0.023). The fastest rate of decline was seen in three groups: IM-MTX with IS-MTX, IS-MTX alone, and IM-MTX with UAE. IM-MTX with IS-MTX and IM-MTX with UAE treatment modalities were superior to IM-MTX alone (p = 0.02 and p < 0.001; respectively).
Conclusion/Implications: IM-MTX combined with IS-MTX or UAE were superior treatment modalities for CSP, while IM-MTX alone did not yield adequate BhCG decline. This is supported by recent guidelines in the management of CSP.
Methods: Retrospective chart review of CSP cases at INOVA Fairfax Hospital between 2012-2019 was conducted. The BhCG levels were trended to determine the rate of decline following treatment. Five treatment modalities were identified: (i) intra-gestational sac methotrexate (IS-MTX) alone; (ii) intramuscular MTX alone (IM-MTX); (iii) IM-MTX with IS-MTX; (iv) IM-MTX with subsequent IS-MTX; and (v) IM-MTX with uterine artery embolization (UAE). Treatment success was defined arbitrarily by BhCG decline to 5% of baseline by week 5 of treatment.
Results: Among 647 ectopic pregnancies treated during the study period, 17 CSP were identified of which 10 cases met inclusion criteria and were used for analyses. All groups differed in the rate of decline of BhCG levels (p = 0.023). The fastest rate of decline was seen in three groups: IM-MTX with IS-MTX, IS-MTX alone, and IM-MTX with UAE. IM-MTX with IS-MTX and IM-MTX with UAE treatment modalities were superior to IM-MTX alone (p = 0.02 and p < 0.001; respectively).
Conclusion/Implications: IM-MTX combined with IS-MTX or UAE were superior treatment modalities for CSP, while IM-MTX alone did not yield adequate BhCG decline. This is supported by recent guidelines in the management of CSP.
Introduction: Cesarean scar pregnancy (CSP) is a rare complication involving the implantation of an embryo in the location of a prior hysterotomy scar. The incidence of CSP is correlated with increasing cesarean delivery rates. Our objective was to evaluate the effectiveness of different treatment modalities for CSP at a single tertiary care institution and formulate an optimal treatment plan.
Methods: Retrospective chart review of CSP cases at INOVA Fairfax Hospital between 2012-2019 was conducted. The BhCG levels were trended to determine the rate of decline following treatment. Five treatment modalities were identified: (i) intra-gestational sac methotrexate (IS-MTX) alone; (ii) intramuscular MTX alone (IM-MTX); (iii) IM-MTX with IS-MTX; (iv) IM-MTX with subsequent IS-MTX; and (v) IM-MTX with uterine artery embolization (UAE). Treatment success was defined arbitrarily by BhCG decline to 5% of baseline by week 5 of treatment.
Results: Among 647 ectopic pregnancies treated during the study period, 17 CSP were identified of which 10 cases met inclusion criteria and were used for analyses. All groups differed in the rate of decline of BhCG levels (p = 0.023). The fastest rate of decline was seen in three groups: IM-MTX with IS-MTX, IS-MTX alone, and IM-MTX with UAE. IM-MTX with IS-MTX and IM-MTX with UAE treatment modalities were superior to IM-MTX alone (p = 0.02 and p < 0.001; respectively).
Conclusion/Implications: IM-MTX combined with IS-MTX or UAE were superior treatment modalities for CSP, while IM-MTX alone did not yield adequate BhCG decline. This is supported by recent guidelines in the management of CSP.
Methods: Retrospective chart review of CSP cases at INOVA Fairfax Hospital between 2012-2019 was conducted. The BhCG levels were trended to determine the rate of decline following treatment. Five treatment modalities were identified: (i) intra-gestational sac methotrexate (IS-MTX) alone; (ii) intramuscular MTX alone (IM-MTX); (iii) IM-MTX with IS-MTX; (iv) IM-MTX with subsequent IS-MTX; and (v) IM-MTX with uterine artery embolization (UAE). Treatment success was defined arbitrarily by BhCG decline to 5% of baseline by week 5 of treatment.
Results: Among 647 ectopic pregnancies treated during the study period, 17 CSP were identified of which 10 cases met inclusion criteria and were used for analyses. All groups differed in the rate of decline of BhCG levels (p = 0.023). The fastest rate of decline was seen in three groups: IM-MTX with IS-MTX, IS-MTX alone, and IM-MTX with UAE. IM-MTX with IS-MTX and IM-MTX with UAE treatment modalities were superior to IM-MTX alone (p = 0.02 and p < 0.001; respectively).
Conclusion/Implications: IM-MTX combined with IS-MTX or UAE were superior treatment modalities for CSP, while IM-MTX alone did not yield adequate BhCG decline. This is supported by recent guidelines in the management of CSP.
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