Local and Systemic Methotrexate Administration Along With Hysteroscopic Treatment of Cesarean Scar Pregnancy

To evaluate treatment outcomes of local and systemic methotrexate (MTX) treatment followed by hysteroscopic removal of the residual gestational mass in women with cesarean scar pregnancy (CSP).

We studied 43 women with CSP between December 2021 and May 2024. We measured treatment outcomes, including changes in β-human chorionic gonadotropin (β-hCG) levels after MTX administration, along with duration to achieve undetectable β-hCG levels and treatment-related complications.

We have enrolled women at a median age of 35.2 ± 4.1 years and a BMI of 25.4 ± 5.3 kg/m². The median gestational age at diagnosis was 8.0 (7.2-9.0) weeks, with a mean gestational sac size of 20.5 ± 4.3 mm and positive fetal cardiac activity in 61.8% (n = 21) women. After a mean time of 49.7 ± 4.8 days, a hysteroscopy was performed. Overall, 41 women (95.3%) were successfully treated and achieved an undetectable β-hCG level, and 2 women had an urgent hysterectomy related to the hemorrhage.

In types II and III of CSP, implementing a combination of local and systemic MTX administration followed by hysteroscopic removal of residual gestational mass is a safe, well-tolerated, and fertility-preserving treatment method.