Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis

Abstract

To report three cases of interstitial pregnancies treated successfully by combining uterine artery embolization (UAE) and ultrasound-guided local administration of methotrexate (MTX); and to assess the effect of UAE on ovarian reserve by prospectively measuring serum antimüllerian hormone (AMH) levels. Case report. Departments of obstetrics and gynecology and radiology of a university hospital. Three patients with interstitial pregnancy. Treatment with multiple IM injections of MTX had failed in cases 1 and 3. Case 2 presented high initial serum beta-hCG levels (93,563 mIU/mL), suggesting the presence of a substantial amount of trophoblastic tissue. All three patients underwent UAE and an ultrasound-guided local injection of MTX under spinal anesthesia. Evolution of serum beta-HCG and AMH levels. Resolution of pregnancies. All three cases presented an appropriate decrease in serum beta-HCG levels, though this reduction was slower in case 2 because of the initial value. Resolution of pregnancy was achieved without complications in all three cases. Levels of AMH were not affected in any of the patients. Interstitial pregnancies with a poor prognosis can be treated successfully with a combination of UAE and local MTX. This approach seems to be safe and maintains the ovarian reserve.