title: Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization.
abstract: OBJECTIVE
  To evaluate the use of uterine artery embolization (UAE) in conjunction with methotrexate in the conservative treatment of cervical ectopic pregnancy (CEP).
  
  
  METHODS
  Case series.
  
  
  METHODS
  Tertiary-care university hospital.
  
  
  METHODS
  Cases of CEP treated at Hutzel Women's Hospital between January 1997 and December 2008.
  
  
  METHODS
  Multidose methotrexate treatment with or without UAE and intra-amniotic potassium chloride injection (KCl).
  
  
  METHODS
  Beta-human chorionic gonadotropin level, vaginal bleeding, length of hospital stay, and future fecundity.
  
  
  RESULTS
  A retrospective analysis of 15 patients with CEP treated conservatively using methotrexate with leucovorin rescue (MTx/Leu) alone (group 1, five cases), with UAE as an adjunctive therapy (group 2, six cases), or also having received intra-amniotic KCl before UAE (group 3, four cases) is reported. There was no significant difference in age, parity, or gestational age among treatment groups. The median β-hCG level on presentation was 9,606 mIU/mL for group 1, 26,516 mIU/mL for group 2, and 130,464 mIU/mL for group 3. The difference was found to be statistically significant. No patients developed complications from UAE. Of the 10 patients who underwent UAE, 2 subsequently had confirmed viable pregnancies.
  
  
  CONCLUSIONS
  Uterine artery embolization with methotrexate is an option for minimally invasive intervention in the treatment of CEP.
authors.affiliation: Division of Gynecology, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan 48201, USA. mzakaria@med.wayne.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Zakaria
authors.forename: Mazen E
authors.initials: ME
authors.lastname: Abdallah
authors.forename: Valerie I
authors.initials: VI
authors.lastname: Shavell
authors.forename: Jay M
authors.initials: JM
authors.lastname: Berman
authors.forename: Michael P
authors.initials: MP
authors.lastname: Diamond
authors.forename: David C
authors.initials: DC
authors.lastname: Kmak
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002584:Cervix Uteri; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D002955:Leucovorin / Q000008:administration & dosage; D008727:Methotrexate / Q000008:administration & dosage; D011189:Potassium Chloride / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000628:therapy*; D012189:Retrospective Studies; D055988:Uterine Artery; D014803:Vitamin B Complex / Q000008:administration & dosage
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D014803:Vitamin B Complex; D011189:Potassium Chloride; D002955:Leucovorin; D008727:Methotrexate