Preoperative Uterine Artery Embolization and Evacuation in the Management of Cervical Pregnancy: Report of Two Cases

Abstract

Preoperative uterine artery embolization and cervical evacuation as conservative management of cervical pregnancy has been tried in recent years. However, cervical suturing, vasoconstrictor injection, or cervical ballooning was frequently used as an ancillary measures in those procedures in most of the previous studies. We report two cases of cervical pregnancy that were successfully treated with preoperative uterine artery embolization and removal of gestational material without ancillary procedures. Our therapeutic modality seems to be safe and effective for conservative management of cervical pregnancy.

Three-Dimensional Ultrasonographic Diagnosis of a Cervical Pregnancy

“…7 The present widespread use of ultrasonography has allowed early diagnosis of cervical pregnancies (even before clinical manifestations), leading to more conservative management. [10][11][12] Conservative management techniques include the following: i) cervical curettage with balloon tamponade [13][14] ; ii) ligature of the hypogastric or cervico-vaginal arteries [15][16] ; iii) elective angiographic embolization of the uterine artery [17][18][19][20] ; and iv) clinical use of methotrexate. [21][22] In the present case, conservative management with methotrexate was chosen because the β-HCG level was less than 10,000 IU/mL and fetal heart activity was absent.…”

Conservative treatment of a twin cervical pregnancy with uterine artery embolization

“…This procedure has many complications, including pelvic infection, pelvic pain, ischemia of tissues, and complications from angiography (1,6). However, it is now the method of choice when treatment with methotrexate is too late or fails.…”

“…In cervical pregnancy, a successful association of selective uterine artery embolization with surgical and pharmacological treatment is used by most authors (7-9). Ryu et al (6) performed preoperative embolization of the uterine artery before curettage without injection of any chemotherapeutic agent. Nadisauskiene et al (7) performed systemic methotrexate injection, preoperative unilateral embolization of the uterine artery and curettage, followed by cervical balloon compression.…”

“…There are two ways to treat cervical pregnancy; the conservative one when the fertility is still desired, and the non conservative one, which may be disastrous for young women. The conservative treatment is preferred to hysterectomy by most authors (2,3,(6)(7)(8)(9).…”

“…However, it is now the method of choice when treatment with methotrexate is too late or fails. Pelvic artery embolization reduces the risks inherent to the surgical procedure, avoids massive bleeding during or after the curettage, and reduces time of hospitalization (1,6,8,9).…”