Failure of uterine embolization and methotrexate for the treatment of a cervical pregnancy

BackgroundTo describe unsuccessful conservative management based on combined uterine embolization and methotrexate of a huge cervical pregnancy.DesignCase report.SettingTeaching hospital.Patient(s)A 40-year-old woman was referred with suspected cervical pregnancy.Intervention(s): Systemic methotrexate administration followed by uterine artery embolization and laparotomic hysterectomy.Main outcome measure(s)Quantitative β-hCG serum levels, MRI findings and clinical outcome.Result(s)Ultrasound may misdiagnose cervical ectopic pregnancy with spontaneous miscarriage. MR Imaging shows trophoblast invasion within the uterine cervix. Three days after embolization, angiographic MR Imaging showed repermeabilization due to ovarian–uterine vascular anastomosis. Despite methotrexate treatment and uterine embolization, severe hemorrhaging necessitated hysterectomy.Conclusion(s)Conservative management of cervical pregnancy with methotrexate and uterine artery embolization may be unsuccessful owing to ovarian–uterine vascular anastomosis.