Comparison of Methotrexate and Actinomycin D in the Treatment of Patients with Cesarean Scar Pregnancy, a Randomized Clinical Trial

Setareh Nasiri; Soudabeh Jamali; Elham Saffarieh

doi:10.5812/koomesh-153590

Koomesh

Journal of Semnan University of Medical Sciences

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https://doi.org/10.69107/koomesh-153590

Comparison of Methotrexate and Actinomycin D in the Treatment of Patients with Cesarean Scar Pregnancy, a Randomized Clinical Trial

Author(s):

Setareh Nasiri

¹,

Soudabeh Jamali

²,

Elham Saffarieh

^3,*

1Department of Obstetrics and Gynecology, Endometriosis Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

2Department of Obstetrics and Gynecology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

3Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran

Koomesh:Vol. 27, issue 1; e153590

Published online:Mar 15, 2025

Article type:Research Article

How to Cite:Setareh NasiriSoudabeh JamaliElham SaffariehComparison of Methotrexate and Actinomycin D in the Treatment of Patients with Cesarean Scar Pregnancy, a Randomized Clinical Trial.koomesh.2025;27(1):e153590.https://doi.org/10.69107/koomesh-153590.

Abstract

Background: Cesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy which causes severe complications such as uterine rupture, massive bleeding, and even, hysterectomy. Therapeutic steps in CSP are controversial.

Objectives: In this study, we compare the rate of success, failure and possible complications of methotrexate (MTX) and actinomycin D in the treatment of CSP, in order to determine the efficacy of actinomycin D as an alternative for MTX.

Materials and methods: In a single-blind, randomized clinical trial, 39 patients with ectopic pregnancy in the caesarean scar were assigned to two groups, the first group received MTX (50 mg) and the other group received Actinomycin D (0.5 mg). Mass size and β-Human chorionic gonadotropin (β-HCG) levels were recorded before and after intervention. The prescribed dose was repeated after 7 days if there was no therapeutic result. If the beta level did not decrease or increased after the intervention, it was interpreted as treatment failure and patient referred for surgical treatment.

Results: Two groups were matched in terms of age, parity, and gestational age. Hemoglobin drop (P=0.192), alterations in β-HCG levels (P=0.411), and duration of lowering the β-HCG level and reaching to negative range as an indicator of success treatment (P=0.749) were not significantly different between two groups. In the regression analysis, the initial β-HCG level less than 4700, reduced the need to surgery and treatment failure to one fifth (Exp(β)= 0.222, P=0.033).

Conclusion: In terms of treatment failure, methotrexate and actinomycin D are not superior to each other in the treatment of ectopic pregnancy in cesarean scar, and actinomycin D can be a suitable alternative to methotrexate. The pre-treatment β-HCG level was an important factor in predicting the success of medical treatment.

Keywords

Actinomycin D

Cesarean scar pregnancy (CSP)

Ectopic pregnancy

Methotrexate

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Author(s):

Setareh Nasiri:[PubMed][Scholar]
Soudabeh Jamali:[PubMed][Scholar]
Elham Saffarieh:[PubMed][Scholar]