Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
BMC Pregnancy Childbirth. 2018 Jul 4;18(1):289. doi: 10.1186/s12884-018-1923-x.
To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage.
A retrospective review of all women presenting with CSP treated with ultrasound-guided suction curettage at Tongji Hospital, Wuhan, China, between January 1, 2013 and December 31, 2015, was conducted. Patients were grouped into those not treated with methotrexate before curettage (group 1), treated with methotrexate by intramuscular injection (group 2) and treated with methotrexate by intravenous injection (group 3). The clinical characteristics and outcomes were analyzed.
Among 107 patients, 47 patients were not treated with methotrexate before curettage, 46 patients had methotrexate administered by intramuscular injection and 14 patients had methotrexate injected intravenously. There were no significant differences among the groups in basic and clinical characteristics, such as age, gravity, parity, positive fetal heart beat and gestational age at diagnosis. Patients presented similar initial human chorionic gonadotropin (hCG) levels in all groups. After treatment with methotrexate or curettage, the percentage changes and varied ranges of the hCG levels were also similar in all groups. There were no significant differences in intraoperative blood loss and retained products of conception among the three groups. However group 1 had significantly shorter hospital stays than the two groups that were treated with methotrexate (p<0.001).
By grouping CSP patients who shared similar age, gravity, parity, fetal heart beat positive and gestational age at diagnosis, we found that the presence or absence of methotrexate treatment before curettage resulted in comparable outcomes and hCG levels, although patients who were not treated with methotrexate had significantly shorter stays in the hospital.
评估超声引导吸宫术治疗剖宫产瘢痕妊娠（CSP）患者中全身甲氨蝶呤的疗效。
回顾性分析 2013 年 1 月 1 日至 2015 年 12 月 31 日期间在武汉同济医院接受超声引导吸宫术治疗的 CSP 患者，根据是否在刮宫前行甲氨蝶呤治疗将患者分为三组：未治疗组（1 组）、肌肉注射组（2 组）和静脉注射组（3 组）。分析各组的临床特征和结局。
107 例患者中，47 例未在刮宫前行甲氨蝶呤治疗，46 例行肌肉注射，14 例行静脉注射。3 组患者在年龄、孕次、产次、胎心阳性和诊断时的孕周等基本临床特征方面无显著差异。各组患者的初始人绒毛膜促性腺激素（hCG）水平相似。在接受甲氨蝶呤或刮宫治疗后，各组 hCG 水平的百分比变化和变化范围也相似。3 组患者的术中出血量和残留妊娠物无显著差异。但与接受甲氨蝶呤治疗的 2 组相比，1 组患者的住院时间明显缩短（p<0.001）。
通过对年龄、孕次、产次、胎心阳性和诊断时的孕周相似的 CSP 患者进行分组，我们发现刮宫前行或不行甲氨蝶呤治疗的患者的结局和 hCG 水平相似，但未行甲氨蝶呤治疗的患者的住院时间明显缩短。
