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Fu P, Sun H, Zhang L, Liu R. Efficacy and safety of treatment modalities for cesarean scar pregnancy: a systematic review and network meta-analysis. Am J Obstet Gynecol MFM 2024:101328. [PMID: 38485053 DOI: 10.1016/j.ajogmf.2024.101328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Cesarean scar pregnancy may lead to varying degrees of complications. There are many treatment methods for it, but there are no unified or recognized treatment strategies. This systematic review and network meta-analysis aimed to observe the efficacy and safety of treatment modalities for patients with cesarean scar pregnancy. DATA SOURCES MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from their inception to January 31, 2024. In addition, relevant reviews and meta-analyses were manually searched for additional references. STUDY ELIGIBILITY CRITERIA Our study incorporated head-to-head trials involving a minimum of 10 women diagnosed with cesarean scar pregnancy through ultrasound imaging or magnetic resonance imaging, encompassing a detailed depiction of primary interventions and any supplementary measures. Trials with a Newcastle-Ottawa scale score <4 were excluded because of their low quality. METHODS We conducted a random-effects network meta-analysis and review for cesarean scar pregnancy. Group-level data on treatment efficacy and safety, reproductive outcomes, study design, and demographic characteristics were extracted following a predefined protocol. The quality of studies was assessed using the Cochrane risk-of-bias tools for randomized controlled trials and the Newcastle‒Ottawa scale for cohort studies and case series. The main outcomes were efficacy (initial treatment success) and safety (complications), of which summary odds ratios and the surface under the cumulative ranking curve using pairwise and network meta-analysis with random effects. RESULTS Seventy-three trials (7 randomized controlled trials) assessing a total of 8369 women and 17 treatment modalities were included. Network meta-analyses were rooted in data from 73 trials that reported success rates and 55 trials that reported complications. The findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage demonstrated the highest cure rates, as evidenced by surface under the cumulative ranking curve rankings of 91.2, 88.2, 86.9, and 75.3, respectively. When compared with suction curettage, the odds ratios (95% confidence intervals) for efficacy were as follows: 6.76 (1.99-23.01) for laparoscopy, 5.92 (1.47-23.78) for transvaginal resection, 5.00 (1.99-23.78) for hysteroscopic curettage, and 3.27 (1.08-9.89) for high-intensity focused ultrasound combined with suction curettage. Complications were more likely to occur after receiving uterine artery chemoembolization, suction curettage, methotrexate+hysteroscopic curettage, and systemic methotrexate; hysteroscopic curettage, high-intensity focused ultrasound combined with suction curettage, and Lap were safer than the other options derived from finite evidence; and the confidence intervals of all the data were wide. CONCLUSION Our findings indicate that laparoscopy, transvaginal resection, hysteroscopic curettage, and high-intensity focused ultrasound combined with suction curettage procedures exhibit superior efficacy with reduced complications. The utilization of methotrexate (both locally guided injection and systemic administration) as a standalone medical treatment is not recommended.
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Affiliation(s)
- Peiying Fu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiying Sun
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long Zhang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ronghua Liu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Van X, Bui T, Dinh HT, Van T, Tran A. The Effectiveness of Combined Local and Systemic Methotrexate Treatment in Cesarean Scar Pregnancy Weeks 8 to 14. Gynecol Minim Invasive Ther 2023; 12:170-174. [PMID: 37807983 PMCID: PMC10553595 DOI: 10.4103/gmit.gmit_135_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/20/2023] [Accepted: 03/31/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives This study aims to identify the success rate and correlated factors of combined local and systemic methotrexate (MTX) injection treatment in cesarean scar pregnancy (CSP). Materials and Methods The combined local and systemic MTX administration has been used for CSP weeks 8-14 at Tu Du Maternal Hospital; however, its effectiveness and correlated factors have not been closely investigated. This is a retrospective case series of 123 CSP patients between 8 and 14 weeks of gestation who were treated at Tu Du Hospital from the year 2016 to 2020. Results The success rate, uterine-sparing rate, and side effects of MTX treatment are 50.4%, 95%, and 17.2%, respectively. The factors related to treatment failure with statistical significance included gestational age (odds ratio [OR] = 3.99), residual myometrial thickness >3 mm (OR = 0.37), and postprocedure gestational sac diameter (OR = 1.09). Conclusion Combined local and systemic MTX injection is minimally invasive and effective in CSP weeks 8-14. Therefore, it should be utilized routinely.
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Affiliation(s)
- Xuyen Van
- Department of Obstretric and Gynecology, Tu Du Maternal Hospital, Long An, Vietnam
| | - Thuong Bui
- Department of Obstretric and Gynecology, University of Medicine and Pharmacy, Long An, Vietnam
| | - Hoang The Dinh
- Department of Obstretric and Gynecology, School of Medicine, Vietnam National University, Long An, Vietnam
| | - Thong Van
- Department of Obstretric and Gynecology, TWG Hospital, Long An, Vietnam
| | - Anh Tran
- Department of Obstretric and Gynecology, My Duc Hospital, Ho Chi Minh City, Vietnam
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Qu W, Li H, Zhang T, Zhang Y, Ban Y, Li N, Jiang J, Xie J, Shi W, Hao Y, Li R, Liu W, Cui B. Comparison of different treatment strategies in the management of endogenic caesarean scar pregnancy: a multicentre retrospective study. BMC Pregnancy Childbirth 2022; 22:404. [PMID: 35549886 PMCID: PMC9103451 DOI: 10.1186/s12884-022-04633-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this study was to evaluate the effectiveness and safety of different treatment strategies for endogenic caesarean scar pregnancy (CSP) patients. Methods According to Vial’s standard, we defined endogenic-type CSP as (1) the gestational sac growing towards the uterine cavity and (2) a greater than 0.3 cm thickness of myometrial tissue at the caesarean scar. A total of 447 endogenic CSP patients out of 527 patients from 4 medical centres in China were enrolled in this study. A total of 120 patients were treated with methotrexate (MTX) followed by surgery, 106 received ultrasound-guided curettage directly and 221 received curettage combined with hysteroscopy. The clinical information and clinical outcomes of these patients were reviewed. Successful treatment was defined as (1) no additional treatment needed, (2) no retained mass of conception and (3) serum β subunit of human chorionic gonadotropin (β-hCG) level returning to a normal level within 4 weeks. The success rate was analysed based on these factors. Result Among 447 patients, no significant difference was observed in baseline characteristics between groups except for foetal heartbeat. The success rate was significantly different (p<0.001) among the three groups. The highest success rate of 95.9% was noted in the hysteroscopy group, and the lowest success rate of 84.0% was noted in the curettage group. In addition, the MTX group reported the longest hospital stay and highest expenses, but the curettage group showed the shortest and lowest expenses, respectively. Nevertheless, no difference in blood loss was observed between the groups. Conclusion The combination of curettage and hysteroscopy represents the most effective strategy. Pretreatment with MTX did not result in better clinical outcomes. Ultrasound-guided curettage directly should not be considered a first-line treatment choice for endogenic CSP patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04633-y.
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Affiliation(s)
- Wenjie Qu
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Hua Li
- Department of Gynaecology and Obstetrics, Taian Central Hospital, No.29 Longtan Road Taishan District, Tai'an City, Jinan, 250012, China
| | - Teng Zhang
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Yuan Zhang
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Yanli Ban
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Ningfeng Li
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Jingyan Jiang
- Department of Obstetrics and Gynaecology, Jinan Central Hospital, No.105 Jiefang Road, Jinan, Jinan, 250012, China
| | - Juan Xie
- Department of Gynaecology and Obstetrics, Taian Central Hospital, No.29 Longtan Road Taishan District, Tai'an City, Jinan, 250012, China
| | - Wentian Shi
- Obstetrics and Gynaecology Department, Liaocheng People's Hospital, NO.67 Dongchang West Road, Liaocheng City Jinan, 250012, China
| | - Yiping Hao
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Ruowen Li
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.,Cheeloo College of Medicine, Shandong University, No.44 Wenhua West Road, Jinan, Jinan, 250012, China
| | - Wei Liu
- Obstetrics and Gynaecology Department, Liaocheng People's Hospital, NO.67 Dongchang West Road, Liaocheng City Jinan, 250012, China.
| | - Baoxia Cui
- Department of Gynaecology and Obstetrics, Qilu Hospital of Shandong University, No.107 Wenhua West Road, Jinan, Jinan, 250012, China.
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Heidar Z, Zadeh Modarres S, Abediasl Z, Khaghani A, Salehi E, Esfidani T. Cesarean scar pregnancy treatment: a case series. J Med Case Rep 2021; 15:506. [PMID: 34625100 PMCID: PMC8501523 DOI: 10.1186/s13256-021-03081-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. Case presentation Four Iranian pregnant women aged 29–34 years who were between 5 to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. Conclusion When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.
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Affiliation(s)
- Zahra Heidar
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran
| | - Shahrzad Zadeh Modarres
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran
| | - Zhila Abediasl
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran
| | - Arezo Khaghani
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran
| | - Ensieh Salehi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Tayebeh Esfidani
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shishe Gar Khaneh Alley, Fadaian Islam Ave, Shoosh Sq, Tehran, Iran.
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Zhang Y, Lan R, Li P, Gong T, Wang M. The role of the humanoid diagram teaching strategy in the nursing of women undergoing caesarean section. Am J Transl Res 2021; 13:7983-7989. [PMID: 34377279 PMCID: PMC8340180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
AIM To investigate the application of the humanoid diagram teaching strategy (HDTS) to the care of women undergoing caesarean section. METHODS 80 women undergoing caesarean section were recruited as the study cohort, with 37 patients who underwent caesarean section before the implementation of HDTS placed in the control group (CNG), and the other 43 cases, who underwent caesarean section after the implementation of HDTS, were placed in the study group (SG). We compared the two groups' incidences of postpartum complications, their pain levels, their negative moods, and their nursing satisfaction levels. RESULTS The total postoperative complication rates (uterine adhesions, infections, bleeding, etc.) were 2.33% in the SG and 16.22% in the CNG (P<0.05), and the pain levels were significantly lower in the SG than they were in the CNG (P<0.05). The self-assessment scale (SAS) and self-assessment scale (SDS) scores were lower in the SG than they were in the CNG (P<0.05). Meanwhile, 97.67% of the patients in the SG and 83.78% of the patients in the CNG were satisfied with the nursing care (P<0.05). CONCLUSION HDTS helps to reduce the complication rate following caesarean section, improves the postoperative pain levels and adverse moods, and improves the patients' satisfaction levels with the nursing interventions, so it is of positive significance for the doctor-patient relationship and worthy of clinical promotion and application.
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Affiliation(s)
- Yajing Zhang
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Rongli Lan
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Ping Li
- Internet Hospital Management Office, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Ting Gong
- Department of Urology, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Min Wang
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
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Hüner B, Lato K, Reister F, Janni W, Deniz M. A Scary Complication: Single-center Study on Management and Outcome of Cesarean Scar Pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:311-316. [PMID: 33979891 PMCID: PMC10183945 DOI: 10.1055/s-0041-1728781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
A cesarean scar pregnancy (CSP) is a scary and life-threatening complication of cesarean section (CS). Nevertheless, the incidence of CS is constantly growing. The CSP incidence is 0,15% of pregnancies after CS which represents 6,1% of all ectopic pregnancies in women with condition after CS. Therefore, it should be more present in the clinical daily routine. From mild nonspecific symptoms to hypovolemic shock, diagnosis and therapy must be performed quickly. With the progressive growth of the scar pregnancy, a uterine rupture involves the risk of severe bleeding, and an emergency hysterectomy could be necessary. Prolongation of pregnancy has been successful only in a few cases. We report 11 cases from our hospital in the past 10 years. In the discussion, treatment options of this complication with an increasing incidence, which is associated with serious morbidity and mortality, are presented based on the current literature. Treatment options include drug therapy, but also surgical or combined procedures with radiological intervention.
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Affiliation(s)
- Beate Hüner
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - Krisztian Lato
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - Frank Reister
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - Wolfgang Janni
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - Miriam Deniz
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
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Wu Y, Sun LF, Si YN, Luan XL, Gao YM. Clinical efficacy analysis of different therapeutic methods in patients with cesarean scar pregnancy. Taiwan J Obstet Gynecol 2021; 60:498-502. [PMID: 33966735 DOI: 10.1016/j.tjog.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical efficacy of five therapeutic strategies in patients with CSP. MATERIALS AND METHODS A total of 135 CSP patients were included and divided into five groups based on the treatment they received, including transvaginal resection (Group A), laparoscopic resection (Group B), uterine arterial embolization (UAE) combined with hysteroscopic curettage (Group C), UAE combined with uterine curettage (Group D), and hysteroscopic curettage (Group E). To investigate the clinical efficacy of these strategies, intraoperative bleeding, serum β-hCG levels and recovery time, menstruation recovery time, hormone levels at 1 month after treatment. RESULTS Patients in group A had the lowest postoperative serum β-hCG levels, and the shortest recovery times of both serum β-hCG and menstruation, followed by patients in group B. Group C and D had small amount of blood loss. The hospital stays and costs were low in group E. In addition, the sex hormone levels showed no significant difference among the five groups. CONCLUSION Our results indicated that resection surgery and UAE have good curative effects, but high hospital costs in CSP treatment. The selection of an optimal treatment regimen for CSP should be carried out based on specific conditions of the patients.
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Affiliation(s)
- Yan Wu
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, 266033, Shandong, China
| | - Lei-Fang Sun
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, 266033, Shandong, China
| | - Ya-Nan Si
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, 266033, Shandong, China
| | - Xiao-Li Luan
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, 266033, Shandong, China
| | - Yong-Mei Gao
- Department of Obstetrics and Gynecology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, 266033, Shandong, China.
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Salari N, Kazeminia M, Shohaimi S, Nankali AAD, Mohammadi M. Evaluation of treatment of previous cesarean scar pregnancy with methotrexate: a systematic review and meta-analysis. Reprod Biol Endocrinol 2020; 18:108. [PMID: 33168010 PMCID: PMC7650162 DOI: 10.1186/s12958-020-00666-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND 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. METHOD 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 I2 index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2. RESULTS 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%). CONCLUSION 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.
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Affiliation(s)
- Nader Salari
- grid.412112.50000 0001 2012 5829Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
- grid.412112.50000 0001 2012 5829Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- grid.412112.50000 0001 2012 5829Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shamarina Shohaimi
- grid.11142.370000 0001 2231 800XDepartment of Biology, Faculty of Science, Universiti Putra Malaysia, Serdang, Selangor Malaysia
| | - Anis al-Dawlah Nankali
- grid.412112.50000 0001 2012 5829Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Mohammadi
- grid.412112.50000 0001 2012 5829Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Pristavu A, Vinturache A, Mihalceanu E, Pintilie R, Onofriescu M, Socolov D. Combination of medical and surgical management in successful treatment of caesarean scar pregnancy: a case report series. BMC Pregnancy Childbirth 2020; 20:617. [PMID: 33050911 PMCID: PMC7557042 DOI: 10.1186/s12884-020-03237-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Background There is no clear consensus on the management of caesarean scar pregnancy (CSP), a complex and life-threatening condition. The objective of this study was to present a novel approach to management of CSP that combines medical therapy of multidose methotrexate and mifepristone with active surgical management by uterine curettage and consecutive local haemostasis. Case presentation We report on a prospective case series of six women with first trimester pregnancy, in whom the diagnosis of CSP was confirmed by 2D and color Doppler transvaginal ultrasound and serial hormone chorionic gonadotropin (hCG) testing. Women were between 23 and 36 years old and had at least one previous delivery by caesarean. At admission, gestational age ranged between 6 to 14 weeks, and serum hCG levels between 397 and 23,000 mUI/ml. Upon decision of pregnancy termination, medical management was undertaken in all cases and 1 mg/kg systemic Methotrexate was administered between 1 and 5 daily doses. Mifepristone was part of the treatment in cases with live pregnancy. Surgical management was employed for the cases were an embryo was seen by ultrasound, being prompted by inadequate response to Methotrexate and/or signs of miscarriage with vaginal bleeding. Curettage combined with local isthmic balloon or vaginal pack tamponade prevented further complications. High treatment rates with preservation of fertility was achieved in all patients except one who underwent hysterectomy for invasive placentation. Ultrasound and hCG levels surveillance ensured that the resolution of pregnancy was achieved. Conclusion Women with history of delivery by caesarean section should be carefully monitored in future pregnancies for prompt diagnosis of CSP. Early diagnosis of CSP allows selection of successful conservative therapy. Through this case series we contribute with our experience to the body of knowledge about the management of this serious complication of early pregnancy.
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Affiliation(s)
- Anda Pristavu
- Cuza-Voda Obstetrics and Gynecology University Hospital, Grigore T.Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Angela Vinturache
- Department of Obstetrics & Gynaecology, Women's Centre, John Radcliffe University Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK.
| | - Elena Mihalceanu
- Cuza-Voda Obstetrics and Gynecology University Hospital, Grigore T.Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Radu Pintilie
- Cuza-Voda Obstetrics and Gynecology University Hospital, Grigore T.Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Mircea Onofriescu
- Cuza-Voda Obstetrics and Gynecology University Hospital, Grigore T.Popa University of Medicine and Pharmacy, Iasi, Romania
| | - Demetra Socolov
- Cuza-Voda Obstetrics and Gynecology University Hospital, Grigore T.Popa University of Medicine and Pharmacy, Iasi, Romania
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