Analysis of risk factors for patients with cesarean scar pregnancy treated with methotrexate combined with suction curettage.

ABSTRACT

PURPOSE: To analyze the predictive value of clinical and ultrasound parameters for treatment failure after administration of methotrexate (MTX) in combination with suction curettage (SC) in treatment of cesarean scar pregnancy (CSP) in the early first trimester. METHODS: In this retrospective cohort study, electronic medical records of patients diagnosed with CSP and initially treated between 2015 and 2022 with MTX combined with SC were reviewed and outcome data were collected. RESULTS: 127 patients met inclusion criteria. 25 (19.69%) required additional treatment. Logistic regression analysis indicated that factors independently associated with the need for additional treatment included progesterone level > 25 mIU/mL (OR 1.97; 95% CI 0.98-2.87, P = 0.039), abundant blood flow (OR 5.19; 95% CI 2.44-16.31, P = 0.011), gestational sac size > 3 cm (OR 2.54; 95% CI 1.12-6.87, P = 0.029), and the myometrial thickness between the bladder and gestational sac < 2.5 mm (OR 3.48; 95% CI 1.91-6.98, P = 0.015). CONCLUSIONS: Our study identified several factors which increase the need for additional treatment following the initial treatment of CSP with MTX and SC. Alternative therapy should be considered if these factors are present.