Objective: To investigate the efficacy and safety of ultrasound-guided local injection of methotrexate (MTX) in the treatment of cesarean scar pregnancy (CSP) diagnosed in the first trimester.
Study Design: The clinical and imaging data of 101 CSP patients who received ultrasound-guided local injection of MTX in our hospital between January 2007 and December 2018 were retrospectively analyzed. The decline in serum β human chorionic gonadotropin (βHCG) level, size and blood flow of lesions, vaginal bleeding, liver/kidney functions, and other indicators were observed or tested after treatment on a weekly basis.
Results: The duration of amenorrhea was 6.1 ± 0.8 weeks (range: 5.7-8.1 weeks) and the initial serum βHCG level was 20,321 ± 965 U/L in 97 patients, The mean time t to βHCG normalization was 40 ± 14 days (range: 21-140 days), Minor intermittent vaginal bleeding occurred after local MTX injection, lasting 25 ± 17 days (range: 10-61 days), and the lesions at the scar sites had completely disappeared with an average interval of 39 ± 29 days ; The treatment failed in four patients. The average duration of amenorrhea was 7.5 weeks and the average initial serum βHCG level was 91,359 U/L.
Conclusion: Ultrasound-guided local injection of MTX is an effective and minimally invasive treatment for CSP. However, it is not feasible for patients with long-term amenorrhea (>8 weeks) and markedly increased blood βHCG level.
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