Methotrexate therapy for cesarean section scar pregnancy with and without suction curettage.

OBJECTIVE: To compare the clinical effects in women with cesarean scar pregnancy (CSP) who were treated with either methotrexate (MTX) regimen only or MTX regimen followed by dilation and curettage (D&C). DESIGN: Prospective consecutive clinical cohort study. SETTING: University hospital for obstetrics, gynecology, and reproductive medicine. SUBJECT(S): Seventy-one cases of CSP. INTERVENTION(S): The subjects were treated with either MTX only (MTX group, 21 cases) or MTX followed by D&C (combined therapy group, 50 cases). MAIN OUTCOME MEASURE(S): Success rates, hysterectomy rates, and time to resolution of serum beta-hCG and the CSP mass were compared between the two groups. RESULT(S): Compared with the MTX group, the combined therapy group had a shorter time to resolution of the CSP mass and serum beta-hCG. There was no significant difference between the MTX and combined therapy groups regarding success rates (76.2% vs. 90.0%, respectively) and hysterectomy rates (19.0% vs. 8.0%, respectively). CONCLUSION(S): Both therapies could treat the majority of CSP patients successfully, but the combined therapy resulted in a shorter time of therapy and indicated a more favorable effect.