Uterine Artery Embolization and Methotrexate Infusion as Sole Management for Cesarean Scar and Cervical Ectopic Pregnancies: A Single-Center Experience

Background: The incidence of cesarean scar pregnancy (CSP) and cervical pregnancy (CP) increased significantly in recent years. The related heamorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. Method(s): A retrospective study was conducted for eleven patients (age range from 25-40 year, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mlU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6 to 24 months included weekly sonography and b-hCG level assessment. Result(s): In ten patients, UAE controlled active vaginal bleeding and reduced post- procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved and uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. Conclusion(s): UAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.

Publication History

Article published online:
11 May 2021