{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T22:07:50Z","timestamp":1740175670580,"version":"3.37.3"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"01","license":[{"start":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T00:00:00Z","timestamp":1694995200000},"content-version":"vor","delay-in-days":260,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultrasound Int Open"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The purpose of the study was to assess the efficacy of local\n                        ultrasound-guided methotrexate injection in patients with caesarean section scar\n                        pregnancy, to chart the course of beta-human chorionic gonadotropin levels (HCG)\n                        after treatment, and to see if HCG levels are correlated with clinical\n                        presentation.<\/jats:p><jats:p>Between May 2018 and January 2021, data were collected\n                        retrospectively from the Early Pregnancy Unit of a tertiary hospital.<\/jats:p><jats:p>Our clinic assessed 20 patients; one disputed terminating the\n                        pregnancy and was not included in the research. The remaining 19 patients, with\n                        a median age of 34 years, received intragestational sac methotrexate injection\n                        under ultrasound guidance. 7w3d was the median gestational age. These women had\n                        one to four previous caesarean sections, with a mean of 1.60\u00b19. Patients\n                        with caesarean scar pregnancy most typically presented with spotting\n                        (42.1%), whereas 26.3% were asymptomatic. Except in cases of\n                        pain, the symptomatic women\u2019s HCG levels were lower than in the\n                        non-symptomatic women. The level of HCG in patients with pain was approximately\n                        double that of non-pain patients (p=0.2557). In our series,\n                        intragestational sac methotrexate injection was effective in 17\/19\n                        women, or 89.5% (95%CI: 75.7-100%). HCG levels were\n                        undetectable in 97.6\u00b130 days on average (minimum: 42 days, maximum: 147\n                        days).<\/jats:p><jats:p>Caesarean scar pregnancy is a rare possibly fatal condition\n                        with no consensus on the optimal treatment. An experienced Early Pregnancy Unit\n                        member performing local methotrexate injections under ultrasound guidance is a\n                        feasible and successful strategy in clinically stable patients.<\/jats:p>","DOI":"10.1055\/a-2137-8318","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T23:08:14Z","timestamp":1695078494000},"page":"E18-E25","source":"Crossref","is-referenced-by-count":1,"title":["Caesarean Scar Pregnancy: Single Dose of Intrasac Ultrasound-Guided\n                    Methotrexate Injection Seems to be a Safe Option for Treatment"],"prefix":"10.1055","volume":"09","author":[{"given":"Angeliki","family":"Rouvalis","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, National and Kapodistrian University of\n                    Athens \u2013 1st Obstetrics and Gynecology Clinic, Athens,\n                    Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5249-7678","authenticated-orcid":false,"given":"Panagiotis","family":"Vlastarakos","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, National and Kapodistrian University of\n                    Athens \u2013 1st Obstetrics and Gynecology Clinic, Athens,\n                    Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georgios","family":"Daskalakis","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology, National and Kapodistrian University of\n                    Athens \u2013 1st Obstetrics and Gynecology Clinic, Athens,\n                    Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abraham","family":"Pouliakis","sequence":"additional","affiliation":[{"name":"2nd Department of Pathology, National and Kapodistrian University of\n                    Athens School of Medicine, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofoklis","family":"Stavrou","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Tsiriva","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7109-5818","authenticated-orcid":false,"given":"Maria","family":"Giourga","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeliki","family":"Gerede","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of\n                    Thrace, Alexandroupolis, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalliopi","family":"Pappa","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themos","family":"Gregoriadis","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios-Efthymios","family":"Vlachos","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandros","family":"Rodolakis","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekaterini","family":"Domali","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, University of Athens,\n                    Greece, National and Kapodistrian University of Athens \u2013 1st Obstetrics\n                    and Gynecology Clinic, Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"ref1","first-page":"142","article-title":"Pregnancy in a uterine scar sacculus \u2013 an unusual cause of postabortal\n                    haemorrhage. 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Monteagudo","year":"2001","journal-title":"J Ultrasound Med"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/uog.13282","article-title":"Cesarean scar pregnancy and early placenta accreta share common histology","volume":"43","author":"I E Timor-Tritsch","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/uog.16216","article-title":"Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover\n                    sign","volume":"50","author":"G Cali","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0029-1224874","article-title":"Cesarean scar ectopic pregnancy: case series and review of the literature","volume":"27","author":"H Sadeghi","year":"2010","journal-title":"Am J Perinatol"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1111\/jog.12051","article-title":"Bilateral uterine artery chemoembolization combined with dilation and curettage\n                    for treatment of cesarean scar pregnancy: A method for preserving the\n                    uterus","volume":"39","author":"W Lan","year":"2013","journal-title":"J Obstet Gynaecol Res"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1093\/humrep\/deh060","article-title":"Ectopic pregnancies in Caesarean section scars: the 8 year experience of one\n                    medical centre","volume":"19","author":"R Maymon","year":"2004","journal-title":"Hum Reprod"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/ajo.12273","article-title":"Caesarean scar pregnancy: a 10-year experience","volume":"55","author":"J K Ko","year":"2015","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"564764","DOI":"10.3389\/fmed.2020.564764","article-title":"Experience With Medical Treatment of Cesarean Scar Ectopic Pregnancy (CSEP) With\n                    Local Ultrasound-Guided Injection of Methotrexate","volume":"7","author":"A Gerday","year":"2020","journal-title":"Front Med (Lausanne)"}],"container-title":["Ultrasound International 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