SynthesisWomen's health (London, England)
Conservative treatment of cesarean scar pregnancy with the combination of methotrexate and mifepristone: A systematic review.
Synthesis in Women's health (London, England). The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
13 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Uterine Ectopic Pregnancies and Live Births: Systematic Review of the Literature and Concepts Underlying Favorable Outcomes.Medicina (Kaunas, Lithuania) · 2025Pooled it
- Exclusive hysteroscopic approach for the treatment of cesarean scar pregnancy: Systematic review of the literature.Women's health (London, England)Pooled it
- Management and outcomes of heterotopic cesarean scar pregnancies: a single-center retrospective case series.Quantitative imaging in medicine and surgery · 2026Article
- Reproductive Outcomes Following High-Intensity Focused Ultrasound Treatment for Cesarean Scar Pregnancy.International journal of women's health · 2026Article
- Cesarean Scar Pregnancy Case Report in a Grade 2 Maternity and Review of the Literature.Reports (MDPI) · 2025Article
- Misdiagnosis analysis of uterine scar pregnancy after cesarean section.Experimental and therapeutic medicine · 2025Article
- Advances in Gynecological Diseases.Journal of clinical medicine · 2025Article
- A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study.BMC pregnancy and childbirth · 2025Article
- Ectopic Pregnancy within a Cesarean Section Scar: An Unusual Case Report.International medical case reports journal · 2025Article
- An individualized risk prediction tool for ectopic pregnancy within the first 10 weeks of gestation based on machine learning algorithms.Frontiers in medicine · 2025Article
- Development and validation of a nomogram model for predicting postoperative complications of cesarean scar pregnancy based on clinical data.Frontiers in medicine · 2025Article
- Methotrexate-Induced Toxicity After Ultrasound-Guided Intragestational Injection in a Patient with Caesarean Scar Pregnancy-A Case Report.Medicina (Kaunas, Lithuania) · 2024Article
- Ectopic pregnancy management and treatment strategies: A nationwide survey of Czech gynecological facilities.Women's health (London, England)Observational
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCesarean scar pregnancy (CSP) has become more frequent as a direct consequence of the increased number of cesarean deliveries and the advances in imaging. Although some cases are characterized by spontaneous resolution, unrecognized or mishandled CSP has the potential to cause both fetal and maternal morbidity and mortality. However, due to its infrequency, there is no agreement on the best management.
objectiveThe purpose of this study was to evaluate the safety, the risks and effectiveness of medical therapy with methotrexate and mifepristone to better understand its role in CSP therapy.
designThis study is a systematic review. DATA SOURCES AND
methodsThe electronic databases PubMed, Medline, and Scopus were comprehensively searched until December 2023. Medical Subject Headings terms (Cesarean scar pregnancy) AND (Methotrexate) AND (Mifepristone) AND (Medical Therapy) were used to identify the relevant records. Due to the rarity of this pathology, the studies included are all case reports or case series. The methodological quality of the included studies was assessed using the JBI Critical Appraisal Checklist for case reports.
resultsWe included in our review a total of seven cases reported in five manuscripts at the end of the screening process. Our review suggests that this type of combination treatment can be considered. The success rate is 71.4%. Treatment seems to be most effective when beta human chorionic gonadotropin (B-hCG) is below 5,000 mUi/ml and when the gestational sac is less than 20 mm. The absence of fetal heartbeat seems to be a positive prognostic factor for a positive outcome.
conclusionMethotrexate and mifepristone administration can be considered as an alternative first-line effective treatment, especially in case of pregnancy with B-hCG <5,000 mUi/ml and when the gestational sac is less than 20 mm. It is important to individualize the management and treatment according to the clinical condition, the patient's age, number of previous cesarean deliveries, willingness to have other children, and the physicians' experience.
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