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.
Table
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. |