- Email: [email protected]
July 2012 (vol. 207, no. 1, page 14)
www.AJOG.org
CORRECTION 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 Journala Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
1
42
Maymon
2004
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. aCase #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
7
72
Tan
2005
8
77
Seow
2004
1
1
9
81
Yin
2009
4
4
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
No. of cases which MTX was not the 1st line treatment
1
5
Description of the cases, doses of MTX when reported. Second or third line of treatment. Reason for inclusion or exclusion. Case #7; IM MTX (?mg)esuccessful
2
Case #1 IM MTX 1 mg/kg; laparoscopic excision. Case #2 IM MTX 1 mg/kg; local MTX injection; uterine artery embolization. 2
None of the cases were treated with systemic MTX as the only 1st line treatment. Case #1: Successful IM MTX treatment. Case #2: IM MTX considered by us as unsuccessful, since it has persistent mass for 10 mos.
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. (continued)
APRIL 2014 American Journal of Obstetrics & Gynecology
371
Correction
www.AJOG.org
TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
10
82
Marchiole
2004
11
96
Holland
2008
12
98
Hasegawa
2005
13 107
Deans
2010
14 120
Wang
2009
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/m2; 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/m2; 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/m2; additional second MTX needed. Case #3: IM MTX 50 mg/m2; 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.
No. of cases which MTX was not the 1st line treatment
1
Description of the cases, doses of MTX when reported. Second or third line of treatment. Reason for inclusion or exclusion. IM MTX 100 mg; required a curettage and uterine artery embolization. IM MTX 50 mg/m2 successful.
1 1 2
Case #1: IM MTX (?mg); hysteroscopic excision. Case #2: IM MTX (?mg); local MTX (?mg) injection. 21a
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
372 American Journal of Obstetrics & Gynecology APRIL 2014
IM MTX was not the only 1st line treatment.
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.
(continued)
Correction
www.AJOG.org TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
22 217
Yan
2007
23 220
Arslan
2005
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/m2; after 8 days required second dose of IM MTX. Considered complications by our inclusion criteria.
27 236
Chao
2005
28 237
Deb
2007
1
IM MTX 50 mg/m2; 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/m2; vaginal bleeding; resolution. Case #2: IM MTX 50 mg/m2; no embryonic pole seen: required repeating the MTX dose; patient had mucositis and xerophtalmia; defect seen 7 mos later.
31 240
Iyibozkurt
2008
1
32 241
Lam
2002
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
2
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.
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.
1
IM MTX was not the only 1st line treatment.
1a
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 caseedue 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.
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. 1
IM MTX (1 mg/kg, on days 1, 3, 5, and 7); required 2 unplanned multiple doses; considered complication by us. (continued)
APRIL 2014 American Journal of Obstetrics & Gynecology
373
Correction
www.AJOG.org
TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
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.
33 242
O¨zkah
2007
1
IM MTX 50 mg/m2; 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 functionne´.”; 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
38 248
Chuang
2003
39 249
Stevens
2011
40 228
Hassan
41 245
Piccoli
1 1
2008
Total
IM MTX 1 mg/kg; planned multidose x 3; successful.
15
Vasopressin and IM MTX injections were the first line treatments
1
IM MTX 50 mg/m2; failed; local injection; laparoscopic excision.
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.
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.
41
49a
a
See detailed explanation in our response.
CSP, cesarean scar pregnancy; FH, fetal heart; IM, intramuscular; MTX, methotrexate; US, ultrasound; ?mg, dose not stated in the manuscript. a
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.
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
374 American Journal of Obstetrics & Gynecology APRIL 2014
CORRECTION 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 Journala Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
1
42
Maymon
2004
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. aCase #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
7
72
Tan
2005
8
77
Seow
2004
1
1
9
81
Yin
2009
4
4
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
No. of cases which MTX was not the 1st line treatment
1
5
Description of the cases, doses of MTX when reported. Second or third line of treatment. Reason for inclusion or exclusion. Case #7; IM MTX (?mg)esuccessful
2
Case #1 IM MTX 1 mg/kg; laparoscopic excision. Case #2 IM MTX 1 mg/kg; local MTX injection; uterine artery embolization. 2
None of the cases were treated with systemic MTX as the only 1st line treatment. Case #1: Successful IM MTX treatment. Case #2: IM MTX considered by us as unsuccessful, since it has persistent mass for 10 mos.
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. (continued)
APRIL 2014 American Journal of Obstetrics & Gynecology
371
Correction
www.AJOG.org
TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
10
82
Marchiole
2004
11
96
Holland
2008
12
98
Hasegawa
2005
13 107
Deans
2010
14 120
Wang
2009
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/m2; 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/m2; 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/m2; additional second MTX needed. Case #3: IM MTX 50 mg/m2; 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.
No. of cases which MTX was not the 1st line treatment
1
Description of the cases, doses of MTX when reported. Second or third line of treatment. Reason for inclusion or exclusion. IM MTX 100 mg; required a curettage and uterine artery embolization. IM MTX 50 mg/m2 successful.
1 1 2
Case #1: IM MTX (?mg); hysteroscopic excision. Case #2: IM MTX (?mg); local MTX (?mg) injection. 21a
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
372 American Journal of Obstetrics & Gynecology APRIL 2014
IM MTX was not the only 1st line treatment.
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.
(continued)
Correction
www.AJOG.org TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
22 217
Yan
2007
23 220
Arslan
2005
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/m2; after 8 days required second dose of IM MTX. Considered complications by our inclusion criteria.
27 236
Chao
2005
28 237
Deb
2007
1
IM MTX 50 mg/m2; 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/m2; vaginal bleeding; resolution. Case #2: IM MTX 50 mg/m2; no embryonic pole seen: required repeating the MTX dose; patient had mucositis and xerophtalmia; defect seen 7 mos later.
31 240
Iyibozkurt
2008
1
32 241
Lam
2002
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
2
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.
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.
1
IM MTX was not the only 1st line treatment.
1a
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 caseedue 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.
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. 1
IM MTX (1 mg/kg, on days 1, 3, 5, and 7); required 2 unplanned multiple doses; considered complication by us. (continued)
APRIL 2014 American Journal of Obstetrics & Gynecology
373
Correction
www.AJOG.org
TABLE
Reassessing comments on 41 studies cited in a Review article in the Journala
(continued)
Systemic MTX as 1st line treatment
Original No. citation no. Author
No. of unsuccessful No. of successful cases needing secondary treatment Year cases
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.
33 242
O¨zkah
2007
1
IM MTX 50 mg/m2; 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 functionne´.”; 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
38 248
Chuang
2003
39 249
Stevens
2011
40 228
Hassan
41 245
Piccoli
1 1
2008
Total
IM MTX 1 mg/kg; planned multidose x 3; successful.
15
Vasopressin and IM MTX injections were the first line treatments
1
IM MTX 50 mg/m2; failed; local injection; laparoscopic excision.
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.
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.
41
49a
a
See detailed explanation in our response.
CSP, cesarean scar pregnancy; FH, fetal heart; IM, intramuscular; MTX, methotrexate; US, ultrasound; ?mg, dose not stated in the manuscript. a
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.
Timor-Tritsch. Correction. Am J Obstet Gynecol 2014.
374 American Journal of Obstetrics & Gynecology APRIL 2014