July 2012 (vol. 207, no. 1, page 14)




Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012;207:14-29.


The authors of a Review published in July 2012 have created a Table (below) reflecting their reconsideration of 41 of the studies cited in that article. A Letter to the Editors suggesting such rethinking and a Reply from the authors explaining their thoughts in preparing the new table appear in this issue of the Journal.




See related articles, pages 379 and 380



Table

Reassessing comments on 41 studies cited in a Review article in the Journal a






































































































































































































































































































































































































No. Original citation no. Author Year Systemic MTX as 1st line treatment No. of cases which MTX was not the 1st line treatment Description of the cases, doses of MTX when reported. Second or third line of treatment. Reason for inclusion or exclusion.
No. of successful cases No. of unsuccessful cases needing secondary treatment
1 42 Maymon 2004 1 Case #7; IM MTX (?mg)–successful
2 51 Ficicioglu 2009 1 IM MTX 75 mg; 7 days later second dose of IM MTX; 2 wks later laparotomy and resection.
3 53 Bignardi 2010 2 Case #1: IM MTX 1 mg/kg; required second dose of IM MTX; persistent defect repaired laparoscopically. Case #2: IM MTX 1 mg/kg; required 2 additional doses of IM MTX; transrectal US guided aspiration. a Case #1 considered complication based upon our inclusion criteria.
4 54 De Vaate 2010 1 3 IM MTX 50 mg; 3 wks later sac still seen; laparotomy and resection 2 mos later. In 3 cases, systemic MTX was not the only 1st line treatment.
5 60 Sadeghi 2010 1 3 Case #1 IM MTX 1 mg/kg. On day 7 hCG quadrupled, hysterectomy done. Case #2 and #3 IM MTX was combined with local injection of MTX. Case #4 IM MTX was not the only 1st line treatment.
6 70 Mitchener 2009 5 2 Case #1 IM MTX 1 mg/kg; laparoscopic excision. Case #2 IM MTX 1 mg/kg; local MTX injection; uterine artery embolization.
7 72 Tan 2005 2 None of the cases were treated with systemic MTX as the only 1st line treatment.
8 77 Seow 2004 1 1 Case #1: Successful IM MTX treatment. Case #2: IM MTX considered by us as unsuccessful, since it has persistent mass for 10 mos.
9 81 Yin 2009 4 4 34 Article translated from Chinese by us. 4 cases: IM MTX successful IM MTX treatment. 4 cases: IM MTX; all required curettage. 34 cases: were not treated by IM MTX as the 1st line treatment.
10 82 Marchiole 2004 1 IM MTX 100 mg; required a curettage and uterine artery embolization.
11 96 Holland 2008 1 IM MTX 50 mg/m 2 successful.
12 98 Hasegawa 2005 1 IM MTX was not the only 1st line treatment.
13 107 Deans 2010 2 Case #1: IM MTX (?mg); hysteroscopic excision. Case #2: IM MTX (?mg); local MTX (?mg) injection.
14 120 Wang 2009 21 a a In these 21 cases a single 100 mg MTX was administered intravenously. Even though we regard an IV administration as a form of systemic use, we excluded these from this revised statistics. In fact, 14 of the 21 cases had an excess bleeding over 200 mL (our inclusion criteria for complications) and 2 had hysterectomy. Only 7 cases were successful.
15 126 Little 2010 1 IM MTX (?mg); vaginal bleeding; uterine artery embolization.
16 128 Lam 2004 2 Case #1: IM MTX 1 mg/kg; persistent FH; laparoscopic excision. Case #2: IM MTX 1 mg/kg; vaginal bleeding; hysterectomy.
17 134 Dieh 2008 1 IM MTX 50 mg/m 2 ; at 9-10 wks transabdominal local MTX injection.
18 144 Hois 2008 1 IM MTX 77 mg; mild vaginal bleeding; uterine artery embolization.
19 207 Muraj 2009 3 Case #1: IM MTX 50 mg/m 2 ; 2 additional doses (…“a single dose was not sufficient and multiple doses were required”); hCG increased; local MTX injection. Case #2: IM MTX 50 mg/m 2 ; additional second MTX needed. Case #3: IM MTX 50 mg/m 2 ; additional second IM MTX needed 7 days later (“It took 11 weeks for the hCG to drop”). Case #2 and #3 were considered by us as complications by our inclusion criteria.
20 212 Hwu 2005 1 1 Case #1: Four doses IM MTX 1 mg/kg in alternating days; required US guided curettage. Case #2: IM MTX was not the only 1st line treatment.
21 213 McKenna 2008 1 1 Case #1: IM MTX 2 injections of 50 mg 2 days apart; sustained FH beats; local MTX injection. Case #2: IM MTX was not the only 1st line treatment.
22 217 Yan 2007 2 2 Case #1: IM MTX 45 mg; required uterine artery embolization. Case #2: IM MTX 75.5 mg; hCG increased; second IM MTX was given; laparoscopic excision. In 2 cases: IM MTX was not the only 1st line treatment; combined with other treatment.
23 220 Arslan 2005 1 IM MTX was not the only 1st line treatment.
24 222 Goynumer 2009 1 IM MTX 60 mg; hCG increased; local KCL and MTX injection required D&C.
25 232 Wang 2005 1 IM MTX 50 mg; after 7 days FH beats positive; laparoscopic excision.
26 235 Ayas 2007 1 IM MTX 50mg/m 2 ; after 8 days required second dose of IM MTX. Considered complications by our inclusion criteria.
27 236 Chao 2005 1 a This was a special case; CSP was diagnosed and a D&C missed the scar pregnancy altogether. Thirteen days later the pregnancy was still present, therefore 4 doses of 50 mg IM MTX was administered over 4 days; vaginal bleeding occurred requiring hysteroscopic excision. This case–due to the first inadequate procedure and multiple failed systemic MTX could easily be considered an unsuccessful systemic treatment, although, we did not include it as a failure.
28 237 Deb 2007 1 IM MTX 50 mg/m 2 ; after 10 days vaginal bleeding; hysteroscopic excision due to persistent bleeding.
29 238 Graesslin 2005 1 IM MTX 50 mg; vaginal bleeding; curettage.
30 239 Haimov-Kochman 2002 1 1 Case #1: IM MTX 50 mg/m 2 ; vaginal bleeding; resolution. Case #2: IM MTX 50 mg/m 2 ; no embryonic pole seen: required repeating the MTX dose; patient had mucositis and xerophtalmia; defect seen 7 mos later.
31 240 Iyibozkurt 2008 1 Planned repeat doses of IM MTX; multidose over 2 days. In this case, the multiple dose was planned and the additional dose was not given as a recue dose as some of the other cases.
32 241 Lam 2002 1 IM MTX (1 mg/kg, on days 1, 3, 5, and 7); required 2 unplanned multiple doses; considered complication by us.
33 242 Özkah 2007 1 IM MTX 50 mg/m 2 ; hCG increased; FH positive; hysteroscopic excision.
34 243 Paillocher 2005 1 IM MTX 1 mg/kg; 39 days of continuous bleeding requiring hospitalization. We regarded this as a complication.
35 244 Persadie 2005 1 Article in French. IM MTX (?mg); “le treatment n’a pas functionné…”; therefore, local injection of MTX.
36 246 Ravhon 1977 1 IM MTX 80 mg; prolonged bleeding and discharge; 9 wks later transvaginal US guided needle aspiration.
37 247 Shufaro 2001 1 IM MTX 1 mg/kg; planned multidose x 3; successful.
38 248 Chuang 2003 1 Vasopressin and IM MTX injections were the first line treatments
39 249 Stevens 2011 1 IM MTX 50 mg/m 2 ; failed; local injection; laparoscopic excision.
40 228 Hassan 1 Diagnosis made by transvaginal US. No treatment was given for 5 days, however the hCG increased therefore an additional dose of IM MTX was given. Laparoscopic excision was necessary after 3 mos.
41 245 Piccoli 2008 1 Twin CSP. Multidose IM MTX (1 mg/kg) was given on days 0, 7, and 15. On day 19, FH was positive. On day 33, US guided aspiration was performed.
Total 15 41 49 a a See detailed explanation in our response.

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May 11, 2017 | Posted by in GYNECOLOGY | Comments Off on July 2012 (vol. 207, no. 1, page 14)

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