Combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection for conservative management of cervical pregnancy.
OBJECTIVE
To evaluate whether the combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection may eliminate unexpected and uncontrolled massive uterine bleeding without compromising future fertility in women with cervical pregnancy.


METHODS
Prospective study (Canadian Task Force classification II-2).


METHODS
Tertiary-care university hospital.


METHODS
Three women.


METHODS
Laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection.


RESULTS
Three cases of cervical pregnancy were diagnosed by ultrasound at 6, 7, and 9 weeks' gestation. After treatment, all three women experienced intermittent vaginal bleeding, but none required transfusion. Levels of b-human chorionic gonadotropin returned to normal within 7 weeks, and patients resumed normal menstruation within 11 weeks after treatment. One woman conceived an intrauterine pregnancy 3 months after restoration of normal menstruation, and was delivered at term.


CONCLUSIONS
The combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection appears to be effective in preventing unexpected massive uterine bleeding in patients with cervical pregnancy, and does not compromise future fertility.
Department of Obstetrics and Gynecology, Chang Gung Memoreial Hospital, Kaohsiung, Taiwan, Republic of China.
Hao
H
Lin
Fu-Tsai
FT
Kung
D000328:Adult; D000650:Amnion / Q000187:drug effects; D002584:Cervix Uteri; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015552:Injections, Intralesional; D010535:Laparoscopy / Q000379:methods*; D008026:Ligation / Q000379:methods; D008727:Methotrexate / Q000008:administration & dosage*; D010298:Parity; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000098:blood supply*
D008727:Methotrexate