Purpose: In this work, we tried to evaluate the effects of systemic methotrexate (MTX) in caesarean scar pregnancy (CSP) in patients treated with ultrasound-guided manual vacuum aspiration (MVA).
Patients and Methods: A prospective non randomized comparative study that was initially conducted on 50 cases diagnosed with caesarean scar pregnancy at Mansoura University hospital in one year from August 2021 till August 2022.
In the assessment of treatment outcome, we included patients who met the following criteria: (1) they were diagnosed with undisturbed caesarean scar pregnancy. (2) The residual myometrial thickness was more than 3mm and (3) No contraindication for systemic MTX.
Twenty four cases therefore were excluded as they didn't meet the inclusion criteria, the other 26 cases were divided into two groups, (group 1) included 16 cases who underwent suction using MVA and (group 2) included 10 cases who received intramuscular (MTX) injection (dose of 50 mg/m2) followed by MVA. The clinical characteristics and the outcomes were analysed. Treatments were regarded as successful if there were complete resolution of the CSP mass, no complications, and no requirement to re-treat.
Results: Among (group 1), two cases were complicated with scar hematoma which resolved spontaneously and one case was complicated with severe bleeding and needed urgent laparotomy and hysterectomy was done.
While in (group 2) all of the cases were successful without any detected complications or need for additional treatment.
There were no significant differences among the two groups in demographic and clinical characteristics, such as maternal age, gravidity, parity, fetal cardiac activity, gestational age at diagnosis, thickness of anterior lower uterine wall on US, type of CSP, initial human chorionic gonadotropin (HCG) levels and number of previous caesarean sections.
Conclusion: By grouping CSP patients who shared similar demographic and clinical characteristics we found that when suction by MVA is preceded by MTX injection, it tends to give better results with less complications detected and without further needed intervention.