Multiple VS Single Dose Methotrexate Regimens for Cesarean Scar Pregnancy: A Multicenter Study

Study Objective To assess the outcome of the treatment of cesarean scar pregnancy (CSP) with single dose methotrexate (MTX-SD) versus multiple dose MTX (MTX-MD) protocols. Design A retrospective cohort study from two tertiary medical centers between the years 2011-2019. Setting N/A Patients or Participants The study cohort included all CSPs cases from the two centers. 32 women in the MTX-SD and 32 women in the MTX-MD groups. Interventions MTX-SD, practiced in one medical center, included a single dose of systemic MTX-SD followed by ultrasound guided needle aspiration of the gestational sac in cases with fetal heartbeat. MTX-MD, practiced in the other medical center, included four consecutive doses of MTX, and local KCL in cases with fetal heartbeat. Characteristics and outcomes were compared between both groups. Measurements and Main Results Baseline characteristics did not differ between groups. In the MTX-SD group, the median dose number was one, versus three in the MTX-MD group. In 16 (50%) of the cases of the MTX-SD and in 12 (37.5%) of the cases of the MTX-MD, fetal heartbeat was present and US guided aspiration or KCL injection were performed, respectively. There was no significant difference between the MTX-SD and the MTX-MD groups in total days of admission (17±9.3 vs. 17±12.8 days respectively, p=0.94), need for invasive procedures (12.5% vs. 18.7% respectively, p=0.24), readmission rate (31.3% vs. 21.9% respectively, p=0.39) and need of blood products (15.6% vs. 3.1% respectively, p=0.19). Conclusion Both MTX-SD and MTX-MD protocols offer high success rate with a relatively low complication rate in the treatment of CSP, with no significant differences between groups.