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

Objective: To evaluate the use of uterine artery embolization (UAE) in conjunction with methotrexate in the conservative treatment of cervical ectopic pregnancy (CEP). Design: Case series. Setting: Tertiary-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.