Combined use of uterine artery embolization and local methotrexate injection in interstitial ectopic pregnancies with poor prognosis
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Published on: February 28, 2014
Gemma Tamarit1, Elena Lonjedo, Miguel González
1Department of Obstetrics and Gynecology, Hospital Universitario Dr. Peset, Avenida Gaspar Aguilar 90, 46017 Valencia, Spain. pellicer_ant@gva.es
Objective:
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.
Design:
Case report.
Setting:
Departments of obstetrics and gynecology and radiology of a university hospital.
Patient(S):
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.
Intervention(S):
All three patients underwent UAE and an ultrasound-guided local injection of MTX under spinal anesthesia.
Main Outcome Measure(S):
Evolution of serum beta-HCG and AMH levels. Resolution of pregnancies.
Result(S):
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.
Conclusion(S):
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.
