Outcomes of Bilateral Uterine Artery Chemoembolization in Combination with Surgical Evacuation or Systemic Methotrexate for Cervical Pregnancy.

STUDY OBJECTIVE

To evaluate the use of bilateral uterine artery chemoembolization in combination with surgical evacuation or systemic methotrexate (MTX) in the conservative treatment of cervical pregnancy (CP).

DESIGN

Clinical case series (Canadian Task Force classification II-3).

SETTING

Tertiary university hospital.

PATIENTS

Women with a CP who were treated at West China Second University Hospital of Sichuan University between January 2006 and January 2013.

INTERVENTION

Bilateral uterine artery chemoembolization in combination with surgical evacuation or systemic MTX.

MEASUREMENTS AND MAIN RESULTS

β-Human chorionic gonadotropin (β-hCG), cervical mass, blood transfusion, length of hospital stay, future menstruation, and fertility were assessed. Thirty-nine patients were successfully treated by chemoembolization in combination with surgical evacuation or systemic MTX. All massive bleeding was controlled after chemoembolization, and the 35 subsequent evacuation surgeries were uneventful. Nine patients received blood transfusions. The time for serum β-hCG normalization was 28.7 ± 9.8 days (range, 7-60). The time for CP mass disappearance by ultrasonography was 27.0 ± 6.9 days (range, 11-48) days. The length of hospital stay was 7.7 ± 4.9 days (range, 3-33). Complications were mainly fever and pain, which were alleviated with symptomatic treatment. Thiry-eight patients had recovered their normal menstruation, and 7 patients had future pregnancies at follow-up.

CONCLUSION

Bilateral uterine artery chemoembolization is effective in controlling and preventing massive hemorrhage associated with CP. It is proved to treat CP with optimal recovery time, few outpatient follow-ups, and efficient fertility preservation when combined with surgical evacuation or systemic MTX.