Mingyi Wang1, Zhiling Yang1, Yunming Li2, Biliang Chen3, Jian Wang3, Xiangdong Ma3, Yu Wang1. 1. Department of Obstetrics and Gynecology, General Hospital of The People's Liberation Army Chengdu Military Region, People's Republic of China. 2. Department of Quality Management, General Hospital of the People's Liberation Army Chengdu Military Region, People's Republic of China. 3. Department of Obstetrics and Gynecology, Xijing Hospital, Fourth Military Medical University Xi'an, Shaanxi, People's Republic of China.
Abstract
PURPOSE: 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). CONCLUSION: 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.
RCT Entities:
PURPOSE: 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). CONCLUSION: The conservative treatments UAE-MTX and USG-MTX were similarly effective in treating CSPpatients. Either treatment was likely to fail for CSPpatients with gestational sac > 5 cm or type II CSP.
Authors: Wouter J K Hehenkamp; Nicole A Volkers; Peter F J Donderwinkel; Sjoerd de Blok; Erwin Birnie; Willem M Ankum; Jim A Reekers Journal: Am J Obstet Gynecol Date: 2005-11 Impact factor: 8.661
Authors: Gabriel Levin; Daniel Shai; Uri P Dior; Ronit Gilad; Asher Shushan; Avi Benshushan; Or Tuval; Alon Ben-David; Roy Mashiach; Raanan Meyer Journal: Arch Gynecol Obstet Date: 2021-01-02 Impact factor: 2.344