Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization

Abstract

The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.

Cervical ectopic pregnancy: 10 year experience at tertiary care hospital and current literature review

“…UAE is optimally employed prior to internal iliac artery ligation or hysterectomy and has various therapeutic advantages, such as avoidance of surgical risks and preservation of fertility. 24,30,49 Although relatively safe UAE complications like uterine infarction, bladder necrosis have been documented. Hwang et al 61 and Hsieh et al 62 recommended vasopressin injection for cervical hemorrhage after local MTX.…”