Masakazu Hirakawa MD, Presenter: Nothing to Disclose

Tsuyoshi Tajima MD, PhD, Abstract Co-Author: Nothing to Disclose

Kengo Yoshimitsu MD, Abstract Co-Author: Nothing to Disclose

Hiroyuki Irie MD, Abstract Co-Author: Nothing to Disclose

Akihiro Nishie MD, Abstract Co-Author: Nothing to Disclose

Hiroshi Honda MD, Abstract Co-Author: Nothing to Disclose

Kousei Ishigami MD, Abstract Co-Author: Nothing to Disclose

Yasuhiro Ushijima MD, Abstract Co-Author: Nothing to Disclose

Daisuke Okamoto MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Cervical ectopic pregnancy (CEP) is potentially associated with life-threatening hemorrhage and often requires hysterectomy to stop the bleeding. Conservative management including uterine artery embolization (UAE) and administration of methotrexate (MTX) is becoming more common as a treatment of CEP to control vaginal bleeding and preserve fertility. The aim of this study is to evaluate the technique and clinical outcomes of UAE for CEP with vaginal bleeding.

UAE for bilateral uterine artery was performed on 8 patients (mean age, 30.1 years; range, 24-37 years) with CEP, as an emergency for control of vaginal bleeding. In six patients gelatin sponge (GS) was used for UAE, and in two patients both GS and metallic coils were used. In six patients, methotrexate into the gestational sac was administrated after UAE. We evaluated the technique, complication and clinical outcome.

In 8 patients (100%), the stasis of bilateral uterine arterial flow was obtained on angiography, and the vaginal bleeding decreased at once. In 6 of 8 patients (75%), the CEP was dramatically resolved. In 2 of 8 patients (25%), on the other hand, with elevation of human chorionic gonadotropin (hCG) levels persisted and regrowth of gestational sac detected on ultrasound, revealed recurrent vaginal bleeding on 15 and 65 days after the first UAE, the bleeding were successfully controlled by additional UAE. There was no complication related to the procedures except abdominal pain that was controlled by NSAIDs. Finally, the uterus was preserved in all patients. Normal menses resumed in 6 of 7 patients who could be followed-up. All of the three patients, who could be followed-up for 2 years over, had subsequent successful natural pregnancies and two patients had successful outcomes.

UAE along with MTX is effective in treating vaginal bleeding associated with CEP while allowing preservation of fertility.

UAE along with methotrexate for cervical pregnancy is effective in preventing vaginal bleeding and allowing preservation of fertility.

Hirakawa, M, Tajima, T, Yoshimitsu, K, Irie, H, Nishie, A, Honda, H, Ishigami, K, Ushijima, Y, Okamoto, D, et al, , et al, , Uterine Artery Embolization for Cervical Ectopic Pregnancy with Vaginal Bleeding: Technique, Complication, and Clinical Outcome.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5003527.html