An Efficient Conservative Treatment Option for Cervical Pregnancy: Transcatheter Intra-Arterial Methotrexate Infusion Combined with Uterine Artery Embolization Followed by Curettage

BACKGROUND The aim of this study was to assess the clinical outcomes of conservative treatments for cervical ectopic pregnancy (CEP). MATERIAL AND METHODS The series of CEP cases at our hospital between 2009 and 2016 were reviewed retrospectively. The patients were treated using systemic methotrexate infusion (MTX group, n=9), angiographic uterine artery embolization (UAE group, n=11), or transcatheter intra-artery methotrexate infusion combined with UAE (UAE+MTX group, n=13). Clinical outcomes, complications, and fertility were evaluated. RESULTS The median serum β-hCG was 6449 mIU/mL for MTX group, 17384 mIU/mL for UAE group, and 21361 mIU/mL for UAE+MTX group. The difference was statistically significant. In the MTX group, 1 patient developed hepatotoxicity and 2 patients occurred continuous vaginal bleeding during curettage. These 3 patients were successfully treated with emergency UAE. In the UAE group, 2 patients had vaginal re-bleeding on postoperative day 17 and 26, respectively, and received a second UAE procedure. In the UAE+MTX group, no patients developed severe complications. Moreover, a quick regression of serum β-hCG level, shortened recovery of normal menstruation, rapid cervical mass elimination, and a short hospital stay were observed in patients of the UAE+MTX group. CONCLUSIONS The triple therapy of transcatheter intra-arterial methotrexate infusion combined with UAE followed by immediate curettage is feasible and advantageous in treating CEP.