Piróg Magdalena, Sarad Jagoda, Skoczylas Dominik, Kacalska-Janssen Olga, Jach Robert
Gynecological Endocrinology Department, Jagiellonian University Medical College, Kraków, Poland.
Gynecological Endocrinology Department, Jagiellonian University Medical College, Kraków, Poland.
J Obstet Gynaecol Can. 2025 Jul;47(7):102925. doi: 10.1016/j.jogc.2025.102925. Epub 2025 Jun 3.
To evaluate treatment outcomes of local and systemic methotrexate (MTX) treatment followed by hysteroscopic removal of the residual gestational mass in women with cesarean scar pregnancy (CSP).
We studied 43 women with CSP between December 2021 and May 2024. We measured treatment outcomes, including changes in β-human chorionic gonadotropin (β-hCG) levels after MTX administration, along with duration to achieve undetectable β-hCG levels and treatment-related complications.
We have enrolled women at a median age of 35.2 ± 4.1 years and a BMI of 25.4 ± 5.3 kg/m. The median gestational age at diagnosis was 8.0 (7.2-9.0) weeks, with a mean gestational sac size of 20.5 ± 4.3 mm and positive fetal cardiac activity in 61.8% (n = 21) women. After a mean time of 49.7 ± 4.8 days, a hysteroscopy was performed. Overall, 41 women (95.3%) were successfully treated and achieved an undetectable β-hCG level, and 2 women had an urgent hysterectomy related to the hemorrhage.
In types II and III of CSP, implementing a combination of local and systemic MTX administration followed by hysteroscopic removal of residual gestational mass is a safe, well-tolerated, and fertility-preserving treatment method.
评估剖宫产瘢痕妊娠（CSP）患者局部和全身应用甲氨蝶呤（MTX）治疗后宫腔镜切除残余妊娠物的治疗效果。
我们研究了2021年12月至2024年5月期间的43例CSP患者。我们测量了治疗效果，包括MTX给药后β-人绒毛膜促性腺激素（β-hCG）水平的变化，以及达到不可检测的β-hCG水平的持续时间和治疗相关并发症。
我们纳入的患者中位年龄为35.2±4.1岁，体重指数为25.4±5.3kg/m²。诊断时的中位孕周为8.0（7.2 - 9.0）周，平均孕囊大小为20.5±4.3mm，61.8%（n = 21）的患者有胎心搏动。平均49.7±4.8天后进行了宫腔镜检查。总体而言，41例（95.3%）患者成功治愈，β-hCG水平降至不可检测，2例患者因出血行急诊子宫切除术。
对于II型和III型CSP，采用局部和全身联合应用MTX后宫腔镜切除残余妊娠物是一种安全、耐受性良好且保留生育功能的治疗方法。
