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DOI:10.2214/AJR.08.1921
AJR 2009; 192:1601-1607
© American Roentgen Ray Society

Original Research

Uterine Artery Embolization Along With the Administration of Methotrexate for Cervical Ectopic Pregnancy: Technical and Clinical Outcomes

Masakazu Hirakawa1, Tsuyoshi Tajima1, Kengo Yoshimitsu1, Hiroyuki Irie1, Kousei Ishigami1, Hideaki Yahata2, Norio Wake2 and Hiroshi Honda1

1 Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University Hospital, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
2 Department of Gynecology and Obstetrics, Graduate School of Medical Sciences, Kyushu University Hospital, Fukuoka, Japan.

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.

MATERIALS AND 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.

CONCLUSION. UAE along with the administration of MTX is effective in treating cervical ectopic pregnancy with vaginal bleeding while allowing the preservation of fertility.

Keywords: cervical ectopic pregnancy • fertility • methotrexate • uterine artery embolization • vaginal bleeding


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