Research
General gynecology
An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage

https://doi.org/10.1016/j.ajog.2010.08.048Get rights and content

Objective

We sought to evaluate a conservative treatment modality, angiographic uterine artery embolization (UAE) followed by immediate curettage, in the treatment of cervical pregnancy.

Study Design

Sixteen patients with cervical pregnancy were first treated by UAE to control or prevent vaginal bleeding. Curettage of cervical canal was performed immediately after UAE to remove gestational tissue from the cervix. Clinical outcome assessments include vaginal bleeding, serum β-human chorionic gonadotropin level, cervical mass, menstruation, fertility, and hospitalization time.

Results

Fifteen patients were successfully treated by UAE followed by immediate curettage. One patient at very early gestational age underwent UAE only. Quick regression of serum human chorionic gonadotropin level and cervical mass, fertility preservation, and a short hospital stay were observed.

Conclusion

UAE followed by immediate curettage is an efficient conservative treatment for cervical pregnancy. This procedure may become a useful alternative to other conservative approaches.

Section snippets

Patients

A total of 20 patients with a confirmed cervical pregnancy were treated in our department from April 2003 through June 2009. All 20 patients wished to preserve fertility and/or obviate hysterectomy. From the original group, 4 patients were successfully treated with MTX-based therapy; 15 patients underwent UAE followed by immediate curettage; and 1 patient underwent UAE only.

Of the 16 patients (mean age, 33.2 years; range, 21–44 years) who underwent UAE, 4 patients were transferred from local

Results

Results of the treatment are summarized in Table 2. Fifteen patients were successfully managed by UAE followed by immediate curettage, and 1 patient underwent UAE only. In all UAE sessions, enlarged and tortuous uterine arteries and increased blood supply to uterus were identified (Figure 1). All sessions successfully achieved the disappearance of uterine arterial flow on bilateral iliac arteriography (Figure 2) and the arrest of vaginal bleeding on pelvic examination. The mean operating time

Comment

The treatment options for cervical pregnancy depend largely on the severity of vaginal bleeding, gestational age, initial serum hCG levels, absence or presence of fetal heartbeat, and the woman's desire to preserve fertility and/or to obviate hysterectomy. Treatments have tended to be more conservative and minimally invasive in recent years. Hysterectomy is performed only as a radical treatment in cases of intractable hemorrhage.

However, a risk of hemorrhage accompanies all options available.

Acknowledgments

We thank Dr FengSheng Yu and Dr XiaoPing Ma for their contributions to the data collection and clinical care in this study.

References (30)

  • F.B. Ushakov et al.

    Cervical pregnancy: past and future

    Obstet Gynecol Surv

    (1997)
  • M.C. Frates et al.

    Cervical ectopic pregnancy: results of conservative treatment

    Radiology

    (1994)
  • D.M. Sherer et al.

    Complete abortion of a nonviable cervical pregnancy following methotrexate treatment

    Am J Perinatol

    (2004)
  • I. Cerveira et al.

    Cervical ectopic pregnancy successfully treated with local methotrexate injection

    Fertil Steril

    (2008)
  • D.M. Sherer et al.

    Viable cervical pregnancy managed with systemic methotrexate, uterine artery embolization, and local tamponade with inflated Foley catheter balloon

    Am J Perinatol

    (2003)
  • Cited by (37)

    • Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population: A Meta-analysis

      2016, Journal of Minimally Invasive Gynecology
      Citation Excerpt :

      However, after uterine arteries are completely occluded by UAE, extensive collateral circulation will be estimated soon. So, if UAE could not terminate the cervical scar pregnancy, the gestational tissues would keep on growing, which would lead to bleeding once again [40]. Curettage is a quick method to evacuate conception tissue, but it would increase the risk of severe vaginal bleeding and the subsequent need for hysterectomy if it were used alone [41].

    • Uterine artery embolization for cervical ectopic pregnancy

      2015, Radiology Case Reports
      Citation Excerpt :

      Aside from methotrexate, other treatment modalities that complement uterine artery embolization can also be used. Curettage alone for cervical ectopic pregnancy is not a viable option because of a high predisposition for uncontrollable bleeding [10]. Once embolization is performed to stem the bleeding risk, curettage can be safely carried out [11].

    • Outcome, complications and future fertility in women treated with uterine artery embolization and methotrexate for non-tubal ectopic pregnancy

      2014, European Journal of Obstetrics and Gynecology and Reproductive Biology
      Citation Excerpt :

      The remaining 5 women were treated successfully with subsequent D&C. Other reports [19,20] of cervical pregnancies which used combined therapy of UAE (without MTX administration) and D&C had favorable results, but with the disadvantages of surgical treatment that we wished to avoid in our cohort. Although the use of UAE with or without systemic MTX treatment has shown favorable results in interstitial pregnancies, data are limited mainly to case reports.

    View all citing articles on Scopus

    Cite this article as: Wang Y, Xu B, Dai S, et al. An efficient conservative treatment modality for cervical pregnancy: angiographic uterine artery embolization followed by immediate curettage. Am J Obstet Gynecol 2011;204:31.e1-7.

    View full text