Transcatheter arterial chemoembolization versus systemic methotrexate for the management of cesarean scar pregnancy

Objective: To evaluate the effectiveness/safety of systemic methotrexate (MTX) treatment versus transcatheter arterial chemoembolization using different embolic agents for termination of cesarean scar pregnancy (CSP). Methods: Women with CSP were randomized to receive intravenous infusion of MIX (group 1, n = 13), or chemoembolization with MIX and either gelatin sponge (GS; group 2, n = 15) or polyvinyl alcohol (PVA; group 3, n = 16) particles. Uterine suction curettage followed all procedures. Bleeding volume, time until resolution of serum beta-hCG, and length of hospital stay were recorded as outcome endpoints. Results: Bleeding volume was smaller in groups 2 (mean +/- SD, 73 +/- 20 mL) and 3 (63 +/- 22 mL) than in group 1 (952 +/- 471 mL) (P<0.001). Time until resolution of beta-hCG was shorter in groups 2 (29 +/- 16 days) and 3 (30 +/- 19 days) than in group 1 (57 +/- 25 days) (P<0.01). Length of hospital stay was shorter in groups 2 (13 +/- 4 days) and 3 (12 +/- 3 days) than in group 1 (36 +/- 8 days) (P<0.01). Conclusion: Transcatheter arterial chemoembolization was more effective than systemic MTX treatment for termination of CSP. Large cohort studies are warranted to compare effectiveness between PVA and GS particles. (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.