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The aim of the study is to compare the effectiveness and the complications of Ultrasound guided surgical evacuation versus using combined local and systemic methotrexate injection for management of caesarean scar pregnancy.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Ultrasound surgical evacuation | Experimental |
| |
| Local and systemic methotrexate injection | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Surgical evacuation and methotrexate injection | Procedure | Surgical evacuation of the scar pregnancy using ultrasound and local and systemic methotrexate injection |
|
| Measure | Description | Time Frame |
|---|---|---|
| Success rate of treatment either by surgical evacuation or by methotrexate injection | The proportion of participants achieving complete resolution of caesarean scar pregnancy without the need of additional intervention | Up to 8 weeks post -intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Bleeding during the procedure | Up to 8 weeks post -intervention | |
| The need for additional intervention | Up to 8 weeks post -intervention | |
| Time for serum-hCG normalisation (days). |
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Inclusion Criteria:
Gestation age Less than 12 weeks. Hemodynamically stable patient with un ruptured CSP. Non disturbed scar pregnancy . Acceptance of possible prolonged follow up, repeated HCG tests, the need for additional treatment doses and possible bleeding and subsequent hysterectomy.
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Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Badr Atef AbdAllah, MD | Contact | +201092975253 | dr.badratef@gmail.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 653492 | Background | Larsen JV, Solomon MH. Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report. S Afr Med J. 1978 Jan 28;53(4):142-3. | |
| 15027012 | Background | Seow KM, Huang LW, Lin YH, Lin MY, Tsai YL, Hwang JL. Cesarean scar pregnancy: issues in management. Ultrasound Obstet Gynecol. 2004 Mar;23(3):247-53. doi: 10.1002/uog.974. |
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| ID | Term |
|---|---|
| D008727 | Methotrexate |
| ID | Term |
|---|---|
| D000630 | Aminopterin |
| D011622 | Pterins |
| D011621 | Pteridines |
| D006574 | Heterocyclic Compounds, 2-Ring |
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| Up to 8 weeks post -intervention |
| Hospital stay (days). | Up to 8 weeks post -intervention |
| Uterine perforation. | Up to 8 weeks post -intervention |
| Occurrence of drug complications | Up to 8 weeks post -intervention |
| 12666214 | Background | Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol. 2003 Mar;21(3):220-7. doi: 10.1002/uog.56. |
| 16738166 | Background | Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol. 2006 Jun;107(6):1373-81. doi: 10.1097/01.AOG.0000218690.24494.ce. |
| 24825421 | Background | Qian ZD, Guo QY, Huang LL. Identifying risk factors for recurrent cesarean scar pregnancy: a case-control study. Fertil Steril. 2014 Jul;102(1):129-134.e1. doi: 10.1016/j.fertnstert.2014.04.003. Epub 2014 May 10. |
| 15375087 | Background | Maymon R, Halperin R, Mendlovic S, Schneider D, Herman A. Ectopic pregnancies in a Caesarean scar: review of the medical approach to an iatrogenic complication. Hum Reprod Update. 2004 Nov-Dec;10(6):515-23. doi: 10.1093/humupd/dmh042. Epub 2004 Sep 16. |
| 12698784 | Background | Yang MJ, Jeng MH. Combination of transarterial embolization of uterine arteries and conservative surgical treatment for pregnancy in a cesarean section scar. A report of 3 cases. J Reprod Med. 2003 Mar;48(3):213-6. |
| 24315547 | Background | Peng KW, Lei Z, Xiao TH, Jia FG, Zhong WX, Gao Y, Shen BX, Xie JW. First trimester caesarean scar ectopic pregnancy evaluation using MRI. Clin Radiol. 2014 Feb;69(2):123-9. doi: 10.1016/j.crad.2013.07.021. Epub 2013 Dec 6. |
| 11169360 | Background | Vial Y, Petignat P, Hohlfeld P. Pregnancy in a cesarean scar. Ultrasound Obstet Gynecol. 2000 Nov;16(6):592-3. doi: 10.1046/j.1469-0705.2000.00300-2.x. No abstract available. |
| 12065130 | Background | Weimin W, Wenqing L. Effect of early pregnancy on a previous lower segment cesarean section scar. Int J Gynaecol Obstet. 2002 Jun;77(3):201-7. doi: 10.1016/s0020-7292(02)00018-8. |
| D000072471 |
| Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |