Kim Young Ran, Moon Myoung Jin
Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
Obstet Gynecol Sci. 2018 Jan;61(1):147-153. doi: 10.5468/ogs.2018.61.1.147. Epub 2017 Dec 12.
To assess the efficacy and safety of ultrasound-guided intragestational injection of methotrexate (MTX) and systemic intramuscular MTX in the management of cesarean scar pregnancies.
This was a retrospective case-control study that included women diagnosed with cesarean scar pregnancy at CHA Bundang Medical Center unit between 2009 and 2015. The 26 cases were managed with local injection of MTX under ultrasound guidance and 15 cases were treated with systemic intramuscular of MTX. After the procedure, serial follow-up sonographic examination and serum beta-human chorionic gonadotropin (β-hCG) measurement were performed.
The mean initial β-hCG level was 20,610.73 mIU/mL and ranged from 263.00-71,316.50 mIU/mL. Mean gestational age was 6.3 weeks and ranged from 4.8 to 8.5 weeks. The majority of ectopic cases were treated successfully and follow-up β-hCG level declined abruptly following the first dose of MTX. The rate of success of local MTX treatment was significantly higher than that of systemic MTX treatment. It was 93.75% vs. 73.33%, respectively (<0.05).
Ultrasound-guided intragestational injection of MTX is an effective method for the management of cesarean scar pregnancies and is associated with minimal side effects and high treatment success.
评估超声引导下孕内注射甲氨蝶呤（MTX）与全身肌内注射MTX治疗剖宫产瘢痕妊娠的疗效及安全性。
这是一项回顾性病例对照研究，纳入2009年至2015年在CHA盆唐医疗中心确诊为剖宫产瘢痕妊娠的女性。26例采用超声引导下局部注射MTX治疗，15例采用全身肌内注射MTX治疗。术后进行系列超声随访检查及血清β-人绒毛膜促性腺激素（β-hCG）测定。
初始β-hCG平均水平为20,610.73 mIU/mL，范围为263.00 - 71,316.50 mIU/mL。平均孕周为6.3周，范围为4.8至8.5周。大多数异位妊娠病例治疗成功，首剂MTX后随访β-hCG水平急剧下降。局部MTX治疗成功率显著高于全身MTX治疗，分别为93.75%和73.33%（<0.05）。
超声引导下孕内注射MTX是治疗剖宫产瘢痕妊娠的有效方法，副作用最小且治疗成功率高。
