Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization

ObjectiveTo evaluate the use of uterine artery embolization (UAE) in conjunction with methotrexate in the conservative treatment of cervical ectopic pregnancy (CEP).DesignCase series.SettingTertiary-care university hospital.Patient(s)Cases of CEP treated at Hutzel Women’s Hospital between January 1997 and December 2008.Intervention(s)Multidose methotrexate treatment with or without UAE and intra-amniotic potassium chloride injection (KCl).Main Outcome Measure(s)Beta-human chorionic gonadotropin level, vaginal bleeding, length of hospital stay, and future fecundity.Result(s)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.Conclusion(s)Uterine artery embolization with methotrexate is an option for minimally invasive intervention in the treatment of CEP.