Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Reprod Biol Endocrinol. 2020 Nov 9;18(1):108. doi: 10.1186/s12958-020-00666-0.
Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP.
This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2.
In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7-93.5%), and complication was 9% (95% CI: 6.3-12.8%).
The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.
既往剖宫产瘢痕妊娠是一种位于子宫肌层和既往剖宫产瘢痕纤维组织中的异位妊娠。这种类型的异位妊娠的治疗方法之一是使用甲氨蝶呤治疗。鉴于甲氨蝶呤治疗剖宫产瘢痕妊娠的各种结果以及缺乏这方面的全球报告，我们旨在通过相关文献回顾和研究结果分析，就甲氨蝶呤治疗 CSP 达成全球报告，从而能够更精确地规划以减少 CSP 的并发症。
本综述研究通过检索 2003 年至 2020 年 1 月期间的 SID、Embase、ScienceDirect、Scopus、PubMed 和 Web of Science（ISI）等国内外数据库，提取信息。为了进行荟萃分析，研究采用随机效应模型，并调查了 I 指数的异质性。使用 Comprehensive Meta-Analysis version 2 对数据进行分析。
共有 26 篇纳入了 600 例个体的研究纳入荟萃分析。根据研究结果，干预前β-hCG 水平平均为 28,744.98±4425.1 mIU/ml，干预后为 23,836.78±4533.1 mIU/ml。术中平均出血量（ml）为 4.8±3.76 ml，平均住院时间（天）为 11.7±1.2 天，血清-hCG 正常化时间（天）平均为 41.6±3.2 天，成功率为 90.7%（95% CI：86.7-93.5%），并发症发生率为 9%（95% CI：6.3-12.8%）。
本研究结果表明，甲氨蝶呤显著降低β-hCG 水平，可有效治疗剖宫产瘢痕妊娠及其并发症。
