Background: Cesarean Scar Pregnancy (CSP) is a life-threatening
condition following an ectopic implantation within the scar of a previous
cesarean delivery and no guideline is shared about optimal treatment options.
Methods: We present a retrospective study comparing the outcomes of
patients with CSP diagnosed before the 10th week of gestation treated by systemic
or local Methotrexate (MTX) for pregnancy termination, followed by hysteroscopic
placental removal. After MTX administration, the weekly decrease-rate of beta
Human Chorionic Gonadotropin subunit (-HCG) was adopted as criterion to
indicate a repeated MTX dose (less than 25% decline after 2 weeks) and to
surgery timing (50% decline in two consecutive assessments). Results:
Fourteen patients satisfied the inclusion criteria. Eight and six of them
underwent systemic (group A) and local (group B) MTX administration,
respectively. No significant difference was found in pre-treatment and
intra-operative variables. Group B showed significantly accelerated times in
weekly halving of -HCG with respect to group A (p-value = 0.005).
Accordingly, the elapsing time between MTX and surgery was found to be
significantly longer in the group A than in the group B (p-value = 0.016).
In group B no patient required further MTX administration whereas 3 out of 8
patients from group A required an additional MTX dose. In all patients
hysteroscopic surgery resulted uneventful and no further treatment was required.
Conclusions: When followed by hysteroscopic placental removal, systemic
or local MTX administration resulted effective to treat CSP. Local MTX allows
quicker trophoblastic demise, leading to significant anticipation of surgery with
respect to systemic administration.