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 MTX (group 1, n=13), or chemoembolization with MTX 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 β-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 β-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.