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CardioVascular and Interventional Radiology

Erschienen in:

01.04.2012 | Clinical Investigation

Uterine Artery Embolization Combined with Local Methotrexate and Systemic Methotrexate for Treatment of Cesarean Scar Pregnancy with Different Ultrasonographic Pattern

verfasst von: Fan Lian, Yu Wang, Wei Chen, Jiaping Li, Zhongping Zhan, Yujin Ye, Yunxiao Zhu, Jia Huang, Hanshi Xu, Xiuyan Yang, Liuqin Liang, Jianyong Yang

Erschienen in: CardioVascular and Interventional Radiology | Ausgabe 2/2012

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Abstract

Purpose

This study was designed to compare the effectiveness of systemic methotrexate (MTX) with uterine artery embolization (UAE) combined with local MTX for the treatment of cesarean scar pregnancy (CSP) with different ultrasonographic pattern, and to indicate the preferable therapy in CSP patients.

Methods

The results of 21 CSP cases were reviewed. All subjects were initially administrated with systemic MTX (50 mg/m² body surface area). UAE combined with local MTX was added to the patients who had failed systemic MTX. The transvaginal ultrasonography data were retrospectively assessed, and two different ultrasonographic patterns were found: surface implantation and deep implantation of amniotic sac. The management and its effectiveness for patients with the two ultrasonographic patterns were studied retrospectively. Ultrasound scan and serum β-hCG were monitored during follow-up. Data were analyzed with the Student’s t test.

Results

Nine patients were successfully treated with systemic MTX. The remaining 12 cases were successfully treated with additional UAE combined with local MTX. According to the classification by Vial et al. of CSP on ultrasonography, most surface implanted CSPs (8/11, 72.7%) could be successfully treated with systemic MTX, whereas most deeply implanted CSPs (9/10, 90%) had failed systemic MTX but still could be successfully treated with additional UAE combined with local MTX. All patients recovered without severe side effects. Most patients with a future desire for reproduction achieved subsequent pregnancy.

Conclusions

For CSP patients suitable for nonsurgical treatment, UAE combined with local MTX would be the superior option compared with systemic MTX in the cases with deep implantation of amniotic sac.

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Titel: Uterine Artery Embolization Combined with Local Methotrexate and Systemic Methotrexate for Treatment of Cesarean Scar Pregnancy with Different Ultrasonographic Pattern
verfasst von: Fan Lian
Yu Wang
Wei Chen
Jiaping Li
Zhongping Zhan
Yujin Ye
Yunxiao Zhu
Jia Huang
Hanshi Xu
Xiuyan Yang
Liuqin Liang
Jianyong Yang
Publikationsdatum: 01.04.2012
Verlag: Springer-Verlag
Erschienen in: CardioVascular and Interventional Radiology / Ausgabe 2/2012
Print ISSN: 0174-1551
Elektronische ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-011-0097-y

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Uterine Artery Embolization Combined with Local Methotrexate and Systemic Methotrexate for Treatment of Cesarean Scar Pregnancy with Different Ultrasonographic Pattern