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28 February 2019 : Clinical Research

An Efficient Conservative Treatment Option for Cervical Pregnancy: Transcatheter Intra-Arterial Methotrexate Infusion Combined with Uterine Artery Embolization Followed by Curettage

Wei Ding12BDEF, Xiaona Zhang3C, Pengpeng Qu2AG*

DOI: 10.12659/MSM.913262

Med Sci Monit 2019; 25:1558-1565

Abstract

BACKGROUND: The aim of this study was to assess the clinical outcomes of conservative treatments for cervical ectopic pregnancy (CEP).

MATERIAL AND METHODS: The series of CEP cases at our hospital between 2009 and 2016 were reviewed retrospectively. The patients were treated using systemic methotrexate infusion (MTX group, n=9), angiographic uterine artery embolization (UAE group, n=11), or transcatheter intra-artery methotrexate infusion combined with UAE (UAE+MTX group, n=13). Clinical outcomes, complications, and fertility were evaluated.

RESULTS: The median serum β-hCG was 6449 mIU/mL for MTX group, 17384 mIU/mL for UAE group, and 21361 mIU/mL for UAE+MTX group. The difference was statistically significant. In the MTX group, 1 patient developed hepatotoxicity and 2 patients occurred continuous vaginal bleeding during curettage. These 3 patients were successfully treated with emergency UAE. In the UAE group, 2 patients had vaginal re-bleeding on postoperative day 17 and 26, respectively, and received a second UAE procedure. In the UAE+MTX group, no patients developed severe complications. Moreover, a quick regression of serum β-hCG level, shortened recovery of normal menstruation, rapid cervical mass elimination, and a short hospital stay were observed in patients of the UAE+MTX group.

CONCLUSIONS: The triple therapy of transcatheter intra-arterial methotrexate infusion combined with UAE followed by immediate curettage is feasible and advantageous in treating CEP.

Keywords: Methotrexate, Pregnancy, Ectopic, uterine artery embolization

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750