Uterine artery embolization combined with local infusion of methotrexate and 5- fluorouracil in treating ectopic pregnancy

Gao, Juan; Li, Xiaobing; Chen, Jianwei; Gong, Weidong; Yue, Kun; Wu, Zhiqun

doi:10.1097/md.0000000000009722

Cited by 6 publications

(8 citation statements)

References 13 publications

(16 reference statements)

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“…In replacing traditional laparotomy, early diagnosis of interstitial pregnancy before rupture makes various minimally invasive methods of treatment possible [3]. These medical management approaches include expectant management [3]; laparoscopic surgery [9] with reversible occlusion of uterine arteries and cornuostomy for advanced cases [18]; hysteroscopic management [6,10,14]; medical cytotoxic management [11] with mifepristone [12]; and endovascular therapy [8] with cytotoxic infusional chemotherapy [4].…”

Section: Discussionmentioning

confidence: 99%

“…Interstitial pregnancies account for only 2% to 4% of tubal pregnancies [3]. However, it has been reported that the mortality rate is as high as 2.5%, which is seven times higher than that of typical ectopic pregnancies [4].…”

Section: Introductionmentioning

confidence: 98%

“…Interstitial pregnancy is defined as a rare and potentially dangerous type of ectopic gestation involving implantation in the uterine interstitial portion of the fallopian tube [3,4]. Interstitial pregnancies account for only 2% to 4% of tubal pregnancies [3].…”

Section: Introductionmentioning

confidence: 99%

“…If rupture occurs in the interstitial portion of the uterus, which includes abundant blood supply from a complex pelvic vascular network composed of the uterine artery and anastomosing ovarian artery, definitive management involves life-saving intervention either by laparotomy or, more recently, laparoscopy [3]. However, for the management of hemodynamically stable cases without rupture, a wide range of surgical and non-surgical procedures are available [3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

“…Previously reports demonstrated that uterine artery chemoembolization (UACE), which involves uterine arterial chemotherapy infusion followed by endovascular embolization, is a feasible option for managing interstitial pregnancy [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester

Takeda¹,

Iyoshi²,

Tamauchi³

et al. 2022

Clin. Exp. Obstet. Gynecol.

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Background: With the increased frequency of diagnosis of interstitial pregnancy in the early first trimester, non-surgical management of unruptured interstitial pregnancy has become an important issue. However, management of unruptured interstitial pregnancy by uterine artery chemoembolization (UACE) with dactinomycin has never been evaluated via a case series. Methods: With this aim, a retrospective review of electronic chart records over a five-year period was performed, and a series of cases of unruptured interstitial pregnancy during the first trimester was extracted. Diagnostic procedures included ultrasonography, magnetic resonance imaging (MRI), and laparoscopic examination, if necessary. Conservative treatment regimen included UACE. Additional administration of methotrexate (MTX) was considered when an insufficient decline of serum β-hCG was noted. Clinical characteristics and treatment outcomes are described. Results: Among four women diagnosed with unruptured interstitial pregnancy at six weeks of gestation, one case was managed by laparoscopic cornuostomy due to concerns of rupture after the identification of thinning of the myometrium, whereas the other three cases were initially managed by UACE. One case of proximal interstitial pregnancy was diagnosed solely by MRI, whereas two cases of distal interstitial pregnancy was diagnosed by exploratory laparoscopy. Two cases were successfully managed by UACE alone, whereas one case required additional systemic administration of MTX to achieve resolution of gestational products after UACE. Thereafter, one patient conceived spontaneously and experienced a successful vaginal birth. Conclusions: This small case series emphasizes that UACE is a feasible minimally invasive option for the management of unruptured interstitial pregnancy identified in the early first trimester.

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