Uterine Artery Embolization and Methotrexate Infusion as Sole Management for Caesarean Scar and Cervical Ectopic Pregnancies: A Single-Center Experience and Literature Review

Canadian Association of Radiologists Journal - Tập 70 - Trang 307-316 - 2019
Ali H. Elmokadem1, Rihame M. Abdel-Wahab1, Ahmed A. El-Zayadi2, Mohamed M. Elrakhawy1
1Diagnostic and Interventional Radiology Department, Mansoura University, Mansoura, Egypt
2Gynecology and Obstetrics Department, Mansoura University, Dakahlia, Egypt

Tóm tắt

Introduction The incidence of caesarean scar pregnancy (CSP) and cervical pregnancy (CP) has increased significantly in recent years. The related hemorrhage can be lethal and often needs hysterectomy. This study aims to assess the technical and clinical results of uterine artery embolization (UAE) combined with intra-arterial methotrexate (MTX) infusion for CSP and CP. Methods A retrospective study was conducted for 11 patients (age range from 25–40 years, mean; 31.8 y) with CSP (7/11) and CP (4/11). The diagnosis was confirmed by elevated b-hCG levels (mean 31.245 mIU/mL) with sonography and/or magnetic resonance imaging. They were treated with UAE using particulate embolic material. In all patients, the infusion of MTX (50 mg/m2) was performed before UAE. Follow-up periods after UAE ranged between 6-24 months included weekly sonography and b-hCG level assessment. A literature review was performed using standard online search tools. Results In 10 patients, UAE controlled active vaginal bleeding and reduced post-procedural b-hCG levels significantly by the second week. One patient presented with persistent elevated b-hCG level and vaginal rebleeding. The rebleeding was successfully controlled by second UAE procedure. The ectopic pregnancies were resolved, and the uterus was preserved in all patients. No major complications were detected. Normal menses resumed within 2 months after UAE. Two patients had subsequent natural successful intrauterine pregnancies. Conclusion UAE combined with intra-arterial MTX infusion resulted in resolution of ectopic pregnancies with control of hemorrhage and without hysterectomy in this small group of patients.

Tài liệu tham khảo

Vora P.H., 2016, J Obstet Gynecol India, 6, 2 Yang H., 2016, Arch Gynecol Obstet, 293, 819, 10.1007/s00404-015-3881-0 Hu J., 2016, BJOG, 123, 97, 10.1111/1471-0528.14005 Wu X., 2012, Eur J Obstet Gynecol Reprod Biol, 161, 75, 10.1016/j.ejogrb.2011.11.026 Zhang B., 2012, J Vasc Interv Radiol, 23, 1582, 10.1016/j.jvir.2012.08.013 Martinelli P., 2007, J Minim Invasive Gynecol, 14, 758, 10.1016/j.jmig.2007.05.017 Zhang S., 2016, Arch Gynecol Obstet, 293, 1043, 10.1007/s00404-015-3929-1 Nakao Y., 2008, Obstet Gynecol, 111, 505, 10.1097/01.AOG.0000286771.10377.4e Ghezzi F., 2002, Eur J Obs Gynecol Reprod Biol, 103, 88, 10.1016/S0301-2115(02)00003-9 Maymon R., 2004, Hum Reprod Update, 10, 515, 10.1093/humupd/dmh042 Gromnica-Ihle E., 2010, Clin Exp Rheumatol, 28, S80 Kanat-pektas M., 2016, Taiwan J Obstet Gynecol, 55, 263, 10.1016/j.tjog.2015.03.009 Nappi C., 1999, Hum Reprod, 14, 1118, 10.1093/humrep/14.4.1118 Lian F., 2012, Cardiovasc Intervent Radiol, 35, 286, 10.1007/s00270-011-0097-y Raskin M.M., 1978, Am J Obs Gynecol, 130, 234, 10.1016/0002-9378(78)90377-0 Lobel S.M., 1990, Obs Gynecol, 76, 938 Hirakawa M., 2009, AJR, 1601, 10.2214/AJR.08.1921 Yu B., 2009, Arch Gynecol Obstet, 279, 721, 10.1007/s00404-008-0775-4 Spies J., 2002, Obstet Gynecol, 5, 873 Qi F., 2015, Taiwan J Obstet Gynecol, 54, 376, 10.1016/j.tjog.2015.01.003 Elito Júnior J., 2013, Case report. Med Ultrason, 15, 240 Li C., 2011, Int J Gynaecol Obstet, 113, 178, 10.1016/j.ijgo.2010.11.027 Liang F., 2010, Acta Obstet Gynecol Scand, 89, 1592, 10.3109/00016349.2010.512973 Yang X.Y., 2010, Br J Obstet Gynaecol, 117, 990, 10.1111/j.1471-0528.2010.02578.x Yang Q., 2009, J Minim Invasive Gynecol, 16, 432, 10.1016/j.jmig.2009.03.015 Zhou Q., 2015, Radiol Case Rep, 10, 72, 10.1016/j.radcr.2015.08.004 Murji A., 2015, J Obstet Gynaecol Can, 37, 1016, 10.1016/S1701-2163(16)30051-2 Radhakrishna K.P., 2014, Journal of South Asian Federation of Menopause Societies, 2, 35 Zakaria M.A., 2011, Fertil Steril, 95, 872, 10.1016/j.fertnstert.2010.12.024 Xiaolin Z., 2010, J Vasc Interv Radiol, 21, 836, 10.1016/j.jvir.2010.02.013 Trambert J.J., 2005, J Reprod Med, 50, 844 Einarsson J.I., 2005, J Minim Invasive Gynecol, 12, 165, 10.1016/j.jmig.2005.01.007 Sherer D.M., 2003, Am J Perinatol, 20, 263, 10.1055/s-2003-42341 Gui B., 2003, Rays, 28, 167 Has R., 2001, Int J Gynecol Obstet, 72, 253, 10.1016/S0020-7292(00)00310-6 Yitzhak M., 1999, Hum Reprod, 14, 847, 10.1093/humrep/14.3.847
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Canadian Association of Radiologists Journal

Tập 70

307-316

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