TITLE:
Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization
AUTHORS:
Hisashi Masuyama, Seiji Inoue, Etsuko Nobumoto, Kei Hayata, Tomonori Segawa, Yuji Hiramatsu
KEYWORDS:
Cervical Pregnancy; Methotrexate; Uterine Artery Embolization; Dilatation and Curettage; Human Chorionic Gonadotropin
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.10,
December
13,
2013
ABSTRACT: The aim of this retrospective case series report
is to evaluate systemic methotrexate therapy in conjunction with uterine artery
embolization (UAE) in the conservative management of cervical pregnancy. We
examined clinical presentations, treatments, and therapeutic outcomes in
fifteen patients with a cervical pregnancy who wished for preservation of
fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve
patients received systemic methotrexate including five treated with UAE. One
was treated with UAE alone. Two patients received neither UAE nor methotrexate
because of a low human chorionic gonadotropin (hCG) level and poor blood flow
around the gestational sac (GS). An increased GS size and the elevated hCG
level during methotrexate therapy might be risk factors for emergent UAE. Two
of six patients treated with UAE had subsequent confirmed viable pregnancies.
In patients with a cervical pregnancy, methotrexate therapy in combination with
UAE can be considered as an option before performing a hysterectomy with
suitable counseling about the risk of loss of fertility. Careful observation of
the GS size and hCG level during methotrexate therapy might be important for
management.