甲氨蝶呤联合米非司酮保守治疗剖宫产瘢痕妊娠的系统评价。
Conservative treatment of cesarean scar pregnancy with the combination of methotrexate and mifepristone: A systematic review.
机构信息
Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy.
Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
出版信息
Womens Health (Lond). 2024 Jan-Dec;20:17455057241290424. doi: 10.1177/17455057241290424.
BACKGROUND
Cesarean scar pregnancy (CSP) has become more frequent as a direct consequence of the increased number of cesarean deliveries and the advances in imaging. Although some cases are characterized by spontaneous resolution, unrecognized or mishandled CSP has the potential to cause both fetal and maternal morbidity and mortality. However, due to its infrequency, there is no agreement on the best management.
OBJECTIVE
The purpose of this study was to evaluate the safety, the risks and effectiveness of medical therapy with methotrexate and mifepristone to better understand its role in CSP therapy.
DESIGN
This study is a systematic review.
DATA SOURCES AND METHODS
The electronic databases PubMed, Medline, and Scopus were comprehensively searched until December 2023. Medical Subject Headings terms (Cesarean scar pregnancy) AND (Methotrexate) AND (Mifepristone) AND (Medical Therapy) were used to identify the relevant records. Due to the rarity of this pathology, the studies included are all case reports or case series. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports.
RESULTS
We included in our review a total of seven cases reported in five manuscripts at the end of the screening process. Our review suggests that this type of combination treatment can be considered. The success rate is 71.4%. Treatment seems to be most effective when beta human chorionic gonadotropin (B-hCG) is below 5,000 mUi/ml and when the gestational sac is less than 20 mm. The absence of fetal heartbeat seems to be a positive prognostic factor for a positive outcome.
CONCLUSION
Methotrexate and mifepristone administration can be considered as an alternative first-line effective treatment, especially in case of pregnancy with B-hCG <5,000 mUi/ml and when the gestational sac is less than 20 mm. It is important to individualize the management and treatment according to the clinical condition, the patient's age, number of previous cesarean deliveries, willingness to have other children, and the physicians' experience.
背景
随着剖宫产分娩次数的增加和影像学技术的进步，剖宫产瘢痕妊娠（CSP）的发生率越来越高。虽然有些病例表现为自发性消退，但未被识别或处理不当的 CSP 有可能导致胎儿和产妇的发病率和死亡率。然而，由于其罕见性，对于最佳治疗方法尚无共识。
目的
本研究旨在评估甲氨蝶呤和米非司酮药物治疗的安全性、风险和有效性，以更好地了解其在 CSP 治疗中的作用。
设计
这是一项系统评价。
数据来源和方法
全面检索了电子数据库 PubMed、Medline 和 Scopus，检索时间截至 2023 年 12 月。使用医学主题词（Cesarean scar pregnancy）和（Methotrexate）和（Mifepristone）和（Medical Therapy）来确定相关记录。由于这种病理的罕见性，纳入的研究均为病例报告或病例系列。使用 JBI 病例报告批判性评价清单评估纳入研究的方法学质量。
结果
在最终的筛选过程中，我们的综述共纳入了来自五篇文献的总共七个病例报告。我们的综述表明，这种联合治疗方法可以考虑使用。成功率为 71.4%。当β人绒毛膜促性腺激素（B-hCG）低于 5000mUi/ml 且妊娠囊小于 20mm 时，治疗效果似乎最佳。没有胎心似乎是一个积极的预后因素。
结论
甲氨蝶呤和米非司酮联合治疗可以作为一种替代的一线有效治疗方法，尤其是在 B-hCG<5000mUi/ml 和妊娠囊小于 20mm 的情况下。根据临床情况、患者年龄、既往剖宫产次数、是否有生育其他孩子的意愿以及医生的经验，个体化管理和治疗非常重要。
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