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“In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience

Background: We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Methods: Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020...

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Autores principales: El Sabbagh, Anthony, Sayour, Ihsan, Sleiman, Zaki, Centini, Gabriele, Lazzeri, Lucia, Giorgi, Matteo, Zupi, Errico, Habib, Nassir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10059207/
https://www.ncbi.nlm.nih.gov/pubmed/36983303
http://dx.doi.org/10.3390/jcm12062304
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author El Sabbagh, Anthony
Sayour, Ihsan
Sleiman, Zaki
Centini, Gabriele
Lazzeri, Lucia
Giorgi, Matteo
Zupi, Errico
Habib, Nassir
author_facet El Sabbagh, Anthony
Sayour, Ihsan
Sleiman, Zaki
Centini, Gabriele
Lazzeri, Lucia
Giorgi, Matteo
Zupi, Errico
Habib, Nassir
author_sort El Sabbagh, Anthony
collection PubMed
description Background: We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Methods: Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020. Twenty-one women with caesarean scar pregnancy underwent a transcutaneous ultrasound-guided direct injection of MTX into the gestational sac in an outpatient setting. Hysteroscopic resection of residual trophoblastic retention was then performed according to perisaccular blood flow. Main results: Two patients had complete spontaneous trophoblast expulsion after MTX injection, and hysteroscopy was performed in 19 patients for residual trophoblastic retention 1 to 12 weeks after MTX injection. Successful preservation of a healthy uterus with the combined procedure was obtained in 94.8% of patients. Hemostatic hysterectomy was required in one patient. Mean hospitalization duration was 1.5 days. Three patients had spontaneous pregnancy after the procedure. Conclusion: Direct MTX injection into the gestational sac for caesarean scar pregnancy followed by hysteroscopic resection was an effective technique with a short hospitalization, fertility preservation and a low major complication rate compared with other modalities of treatment reported in the literature. Further larger prospective comparative studies are needed to confirm the efficacy of this procedure.
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spelling pubmed-100592072023-03-30 “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience El Sabbagh, Anthony Sayour, Ihsan Sleiman, Zaki Centini, Gabriele Lazzeri, Lucia Giorgi, Matteo Zupi, Errico Habib, Nassir J Clin Med Article Background: We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Methods: Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020. Twenty-one women with caesarean scar pregnancy underwent a transcutaneous ultrasound-guided direct injection of MTX into the gestational sac in an outpatient setting. Hysteroscopic resection of residual trophoblastic retention was then performed according to perisaccular blood flow. Main results: Two patients had complete spontaneous trophoblast expulsion after MTX injection, and hysteroscopy was performed in 19 patients for residual trophoblastic retention 1 to 12 weeks after MTX injection. Successful preservation of a healthy uterus with the combined procedure was obtained in 94.8% of patients. Hemostatic hysterectomy was required in one patient. Mean hospitalization duration was 1.5 days. Three patients had spontaneous pregnancy after the procedure. Conclusion: Direct MTX injection into the gestational sac for caesarean scar pregnancy followed by hysteroscopic resection was an effective technique with a short hospitalization, fertility preservation and a low major complication rate compared with other modalities of treatment reported in the literature. Further larger prospective comparative studies are needed to confirm the efficacy of this procedure. MDPI 2023-03-16 /pmc/articles/PMC10059207/ /pubmed/36983303 http://dx.doi.org/10.3390/jcm12062304 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
El Sabbagh, Anthony
Sayour, Ihsan
Sleiman, Zaki
Centini, Gabriele
Lazzeri, Lucia
Giorgi, Matteo
Zupi, Errico
Habib, Nassir
“In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title_full “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title_fullStr “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title_full_unstemmed “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title_short “In Situ” Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience
title_sort “in situ” methotrexate injection followed by hysteroscopic resection for caesarean scar pregnancy: a single-center experience
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10059207/
https://www.ncbi.nlm.nih.gov/pubmed/36983303
http://dx.doi.org/10.3390/jcm12062304
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