Comparative efficacy and safety of local and systemic methotrexate injection in cesarean scar pregnancy

Objective: To investigate the efficacy of methotrexate (MTX) injection in treatment of cesarean scar pregnancy (CSP). Method: A randomized controlled study was performed in 104 CSP patients receiving either local or systemic MTX injection at the Peking Union Medical College Hospital from the year 2008 to 2013. Results: Complete cure was defined as regression of ultrasonographic findings and normalization of serum beta-hCG within 60 days. It was regarded as delayed cure if additional dilation and curettage (D&C) was needed. The overall cure rate (complete cure plus delayed cure) was 69.2% versus 67.3% for local injection versus systemic administration (P>0.05). The median time for serum beta-hCG remission and uterine mass disappearance after systemic administration (42 [21-69] days and 40 [20-67] days) were significantly lower than those receiving local injection (56 [24-92] days and 53 [23-88] days), with P=0.029 and 0.046, respectively. The mean pretreatment serum beta-hCG (human chorionic gonadotropin) level and lesion size in cured group (21,941 +/- 18,351 mIU/mL and 2.9 +/- 1.3 cm, respectively) were significantly lower than those in the failed group (37,047 +/- 30,864 mIU/mL and 3.6 +/- 1.3) with P=0.038 and 0.044, respectively. Conclusion: MTX injection is effective in CSP treatment. Systemic administration shows similar overall cure rate compared to local injection, but requires shorter time for serum beta-hCG remission and uterine mass disappearance.