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.
Highlights
Cervical pregnancy is a rare but potentially life-threatening medical condition and has been reported at an incidence of 1 in 8000 - 18000 deliveries, but the incidence is increasing as a result of assisted reproductive technology [1,2]
We have examined our reports of clinical presentations, treatments and therapeutic outcomes to evaluate our conservative management for patients with a cervical pregnancy
Seventeen cases of cervical ectopic pregnancy were diagnosed at our institution during the study period
Summary
Cervical pregnancy is a rare but potentially life-threatening medical condition and has been reported at an incidence of 1 in 8000 - 18000 deliveries, but the incidence is increasing as a result of assisted reproductive technology [1,2]. 60% of cases of cervical pregnancy were diagnosed at an advanced stage in which lifethreatening hemorrhage occurred after a dilatation and curettage (D&C) or a suspected spontaneous abortion [5]. Such cases often resulted in the need for a hysterectomy and loss of the patient’s fertility. There have been sporadic reports of cases of cervical pregnancy with vaginal bleeding that were controlled by UAE and the administration of MTX to preserve fertility and control bleeding [19]. Combined therapy with MTX has been used and has been recommended by reports of UAE as an initial therapy to treat patients with a cervical pregnancy [22,23]
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