{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T06:15:40Z","timestamp":1778998540581,"version":"3.51.4"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T00:00:00Z","timestamp":1678924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: We evaluated the efficacy of local methotrexate (MTX) treatment followed by hysteroscopic resection for caesarean scar pregnancy and its impact on future fertility. Methods: Monocentric, prospective, observational study performed in the Haykel Hospital between June 2016 and December 2020. Twenty-one women with caesarean scar pregnancy underwent a transcutaneous ultrasound-guided direct injection of MTX into the gestational sac in an outpatient setting. Hysteroscopic resection of residual trophoblastic retention was then performed according to perisaccular blood flow. Main results: Two patients had complete spontaneous trophoblast expulsion after MTX injection, and hysteroscopy was performed in 19 patients for residual trophoblastic retention 1 to 12 weeks after MTX injection. Successful preservation of a healthy uterus with the combined procedure was obtained in 94.8% of patients. Hemostatic hysterectomy was required in one patient. Mean hospitalization duration was 1.5 days. Three patients had spontaneous pregnancy after the procedure. Conclusion: Direct MTX injection into the gestational sac for caesarean scar pregnancy followed by hysteroscopic resection was an effective technique with a short hospitalization, fertility preservation and a low major complication rate compared with other modalities of treatment reported in the literature. Further larger prospective comparative studies are needed to confirm the efficacy of this procedure.<\/jats:p>","DOI":"10.3390\/jcm12062304","type":"journal-article","created":{"date-parts":[[2023,3,16]],"date-time":"2023-03-16T02:40:11Z","timestamp":1678934411000},"page":"2304","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["\u201cIn Situ\u201d Methotrexate Injection Followed by Hysteroscopic Resection for Caesarean Scar Pregnancy: A Single-Center Experience"],"prefix":"10.3390","volume":"12","author":[{"given":"Anthony","family":"El Sabbagh","sequence":"first","affiliation":[{"name":"Department of Surgery, Haykel Hospital, Tripoli 1300, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ihsan","family":"Sayour","sequence":"additional","affiliation":[{"name":"Department of Surgery, Haykel Hospital, Tripoli 1300, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9663-9217","authenticated-orcid":false,"given":"Zaki","family":"Sleiman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-7401","authenticated-orcid":false,"given":"Gabriele","family":"Centini","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-1980","authenticated-orcid":false,"given":"Lucia","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7515-5782","authenticated-orcid":false,"given":"Matteo","family":"Giorgi","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Errico","family":"Zupi","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nassir","family":"Habib","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Francois Quesnay Hospital, 78201 Mantes-La-Jolie, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s00404-012-2617-7","article-title":"Transvaginal surgical treatment of cesarean scar ectopic pregnancy","volume":"287","author":"Le","year":"2013","journal-title":"Arch. 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