TY - JOUR
T1 - hCG values and gestational sac size as indicators of successful systemic methotrexate treatment in cesarean scar pregnancy
AU - Mitsui, Takashi
AU - Mishima, Sakurako
AU - Ohira, Akiko
AU - Tani, Kazumasa
AU - Maki, Jota
AU - Eto, Eriko
AU - Hayata, Kei
AU - Masuyama, Hisashi
N1 - Funding Information:
This work was supported by the society of Obstetrics and Gynecology in Chugoku and Shikoku area.We acknowledge the Society of Obstetrics and Gynecology in the Chugoku and Shikoku areas and thank them for their support. Physicians and institutions that cooperated in this study are mentioned below. Kiyoshi Noda, National Hospital Organization Iwakuni Medical Center. Hiroshi Honda, Tomoya Mizunoe, National Hospital Organization Kure Medical Center. Naoko Ueno, Junichi Kodama, Hiroshima City Hospital. Naoko Terawaki, Yoshiki Kudo, Hiroshima University Hospital. Ayako Urayama, Hideo Fujimoto, Miyoshi Central Hospital. Satoru Tsukihara, Yasunobu Kanamori, Yamaguchi Red Cross Hospital. Masaaki Hasegawa, Kurashiki Central Hospital. Yuko Kurioka, Shimane Prefectural Central Hospital. Takashi Kodama, National Hospital Organization Higashihiroshima Medical Center. Masayuki Saijo, Dan Yamamoto National Hospital Organization Fukuyama Medical Center. Keisuke Okabe, Hisaya Fujiwara, Chugoku Rosai Hospital.
Funding Information:
This work was supported by the society of Obstetrics and Gynecology in Chugoku and Shikoku area.
Publisher Copyright:
© 2021
PY - 2021/5
Y1 - 2021/5
N2 - Objective: To retrospectively investigate cesarean scar pregnancy (CSP) patients who received systemic methotrexate (MTX) and to clarify the criteria for administering systemic MTX to CSP patients. Materials and methods: Fifteen CSP patients who were initially treated with systemic MTX (50 mg/m2/week) were included. Nine patients, who needed a uterine artery embolization (UAE) or a laparotomy, including a transabdominal hysterectomy (TAH), were defined as the unsuccessful MTX group. Six patients who did not require UAE or a laparotomy were defined as the successful MTX group. Furthermore, the hCG cut-off value and the GS cut-off size at the time of CSP diagnosis, which differentiated successful and unsuccessful patients, were defined. MTX success rates were investigated by combining the hCG and gestational sac (GS) size cut-off values. Results: The hCG cut-off value was 17757.0 mIU/mL, and the GS cut-off size was 10.4 mm. In patients with hCG values less than 17757.0 mIU/mL, the MTX success rate was 75.0%. Fewer patients needed UAE or a laparotomy compared to patients with hCG values higher than 17757.0 mIU/mL (P = 0.007). In patients with a GS size less than 10.4 mm, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with a GS size greater than 10.4 mm (P = 0.089). In patients with hCG values and GS sizes lower than the cut-off values, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with hCG values and/or GS sizes higher than the cut-off values, respectively (P = 0.010). Conclusion: Patients with hCG values less than 17757.0 mIU/mL and GS sizes less than 10.4 mm may have a greater chance of successful systemic MTX treatment when it is used as the first line of treatment for CSP.
AB - Objective: To retrospectively investigate cesarean scar pregnancy (CSP) patients who received systemic methotrexate (MTX) and to clarify the criteria for administering systemic MTX to CSP patients. Materials and methods: Fifteen CSP patients who were initially treated with systemic MTX (50 mg/m2/week) were included. Nine patients, who needed a uterine artery embolization (UAE) or a laparotomy, including a transabdominal hysterectomy (TAH), were defined as the unsuccessful MTX group. Six patients who did not require UAE or a laparotomy were defined as the successful MTX group. Furthermore, the hCG cut-off value and the GS cut-off size at the time of CSP diagnosis, which differentiated successful and unsuccessful patients, were defined. MTX success rates were investigated by combining the hCG and gestational sac (GS) size cut-off values. Results: The hCG cut-off value was 17757.0 mIU/mL, and the GS cut-off size was 10.4 mm. In patients with hCG values less than 17757.0 mIU/mL, the MTX success rate was 75.0%. Fewer patients needed UAE or a laparotomy compared to patients with hCG values higher than 17757.0 mIU/mL (P = 0.007). In patients with a GS size less than 10.4 mm, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with a GS size greater than 10.4 mm (P = 0.089). In patients with hCG values and GS sizes lower than the cut-off values, the MTX success rate was 80.0%. Fewer patients among them needed UAE or a laparotomy compared to those among patients with hCG values and/or GS sizes higher than the cut-off values, respectively (P = 0.010). Conclusion: Patients with hCG values less than 17757.0 mIU/mL and GS sizes less than 10.4 mm may have a greater chance of successful systemic MTX treatment when it is used as the first line of treatment for CSP.
KW - Cesarean scar pregnancy
KW - Gestational sac
KW - Human chorionic gonadotropin
KW - Systemic methotrexate
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U2 - 10.1016/j.tjog.2021.03.011
DO - 10.1016/j.tjog.2021.03.011
M3 - Article
AN - SCOPUS:85103947877
VL - 60
SP - 454
EP - 457
JO - Taiwanese Journal of Obstetrics and Gynecology
JF - Taiwanese Journal of Obstetrics and Gynecology
SN - 1028-4559
IS - 3
ER -