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Ultrasound/Imaging

Poster Session 1

(264) BhCG decline following intrasac methotrexate for the management of cesarean-scar ectopic pregnancy: An 11-year experience.

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective:

We sought to compare the rate of beta human chorionic gonadotropin (BhCG) levels decline of a protocol of transvaginal intrasac MTX injection to other non-surgical treatment modalities for the management of cesarean scar ectopic pregnancy (CSEP).

Study Design:

We conducted a case control of CSEP cases at INOVA Fairfax Hospital from September 2012 to March 2023. We abstracted demographic, medical, and obstetric information from medical records. BhCG levels were trended to determine the rate of decline following our protocol of outpatient local intrasac injection of 2.5 mL MTX treatment (IS-MTX) under transvaginal ultrasound guidance compared to (i) only intramuscular methotrexate (IM-MTX), (ii) simultaneous intra-gestational sac methotrexate injection and intramuscular methotrexate (IS-MTX + IM-MTX); (iii) backup intra-gestational sac methotrexate injection given after intramuscular methotrexate treatment failure (IM-MTX / backup IS-MTX); and (iv) simultaneous uterine artery embolization and intramuscular methotrexate (UAE + IM-MTX). Intrasac 1.5 mL KCl was injected prior to IS-MTX whenever a live embryo was present.

Results:

Among 920 ectopic pregnancies reported during the study period, we identified 23 cases of CSEP (2.5%) of which 16 cases had complete data and were included in our study. The fastest rate of BhCG decline was seen in the IS-MTX group and in UAE + IM-MTX. A rapid BhCG decline followed rescue IS-MTX when IM-MTX failed. All treatment modalities did not differ in grouped comparison (P=0.095); nonetheless, individual group comparisons showed significant BhCG decline in the IS-MTX group compared to IM-MTX (P=0.047), and in UAE + IM-MTX compared to IM-MTX (P=0.019) and to IM-MTX / backup IS-MTX (P=0.025). The presence of live embryo did not influence the rate of BhCG decline following IS-MTX.

Conclusion:

IS-MTX alone is superior to IM-MTX. IM-MTX did not accelerate the decline of BhCG when used simultaneously with intrasac MTX (IS-MTX + IM-MTX group) compared to IS-MTX alone. UAE + IM-MTX is a useful non-surgical alternative when IS-MTX is not available.