Uterine artery embolization along with the administration of methotrexate for cervical ectopic pregnancy: technical and clinical outcomes.
OBJECTIVE
The objective of our study was to evaluate the technical and clinical outcomes of uterine artery embolization (UAE) along with the administration of methotrexate (MTX) for cervical ectopic pregnancy with vaginal bleeding as an alternative nonsurgical treatment to control bleeding and preserve fertility.


METHODS
Eight patients (age range, 24-37 years; mean age, 30.1 years) with cervical ectopic pregnancy were treated with UAE using gelatin sponge particles to control vaginal bleeding. In seven patients, the administration of MTX was performed before, after, or before and after UAE. The follow-up periods after UAE ranged from 4 to 46 months (median, 8 months). We evaluated the UAE technique, clinical outcomes, complications, and fertility.


RESULTS
In all patients, UAE could control active vaginal bleeding on gynecologic examination. In six patients, the cervical ectopic pregnancy was dramatically resolved. In the other two patients presenting with both fetal heartbeat before UAE and persistent high HCG levels, active vaginal rebleeding was observed. The rebleeding was successfully controlled by a second UAE procedure. No major complication related to UAE was detected. The uterus could be preserved in all patients. In seven patients, normal menses resumed within 2 months after UAE. In only one patient, amenorrhea continued 8 months after UAE. In all three patients who could be followed for 2 years or more, three had subsequent successful natural pregnancies, and two patients had live births.


CONCLUSIONS
UAE along with the administration of MTX is effective in treating cervical ectopic pregnancy with vaginal bleeding while allowing the preservation of fertility.
Hirakawa
Masakazu
M
Department of Clinical Radiology, Kyushu University Hospital, Kyushu University, Fukuoka, Japan. mahira@radiol.med.kyushu-u.ac.jp
Tajima
Tsuyoshi
T
Yoshimitsu
Kengo
K
Irie
Hiroyuki
H
Ishigami
Kousei
K
Yahata
Hideaki
H
Wake
Norio
N
Honda
Hiroshi
H
D000328:Adult; D002584:Cervix Uteri; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D014592:Uterine Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control*; D055815:Young Adult
D007166:Immunosuppressive Agents; D008727:Methotrexate