Transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization as a treatment option for cervical pregnancy.
OBJECTIVE
To assess the value of transcatheter intraarterial methotrexate infusion combined with selective uterine artery embolization (UAE) as a treatment option for cervical pregnancy.


METHODS
Between January 2004 and June 2009, a prospective study was conducted in 20 consecutive patients with cervical pregnancy. The patients were treated with UAE with gelatin sponge particles (1-2 mm in size) to control active vaginal bleeding. Methotrexate was injected into the arteries before, during, and after UAE.


RESULTS
Two of 20 patients (10%) had recurrent vaginal bleeding of approximately 50 mL daily after treatment; the other 18 (90%) had no significant vaginal bleeding after UAE. Fifteen cases (75%) were treated successfully by a single procedure and five (25%) required a subsequent curettage without blood transfusion. The degeneration of placenta was confirmed by light microscopy after curettage. The cervical gestational sac was eliminated at a mean of 41 days (range, 11-83 d). Increased serum beta-human chorionic gonadotrophin levels normalized by an average of 30 days (range, 7-49 d). The uterus was preserved and normal menses resumed within 2-4 months in all 20 women (100%). Of 16 women who attempted another pregnancy, eight (50%) achieved pregnancy: there were six term pregnancies with live births (38%) and two miscarriages (13%). No obvious complications related to treatment occurred, but a few mild side effects were observed in nine cases (45%).


CONCLUSIONS
Based on this series of 20 patients, the conservative protocol of transcatheter intraarterial methotrexate infusion combined with UAE may be a feasible, effective, and safe option for cervical pregnancy.
Xiaolin
Zhang
Z
Department of Radiology, First College of Clinical Medical Science of China Three Gorges University and Yichang Central People's Hospital, 183, Yiling Road, Yichang, Hubei 443003, China. zhangxiaolin5800@163.com
Ling
Lu
L
Chengxin
Yu
Y
Yiqing
Tan
T
Jun
Wang
W
Yan
Chen
C
Guangxi
Tan
T
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002406:Catheterization, Peripheral; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008727:Methotrexate / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000628:therapy*; D016896:Treatment Outcome; D055357:Uterine Artery Embolization / Q000379:methods*; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate