Conservative treatment of cervical pregnancy with selective unilateral uterine artery embolization

Rūta Nadišauskienė, Edvardas Vaicekavičius¹, Viktorija Tarasevičienė, Daiva Simanavičiūtė

Department of Obstetrics and Gynecology, ¹Department of Radiology, Kaunas University of Medicine, Lithuania

Key words: cervical pregnancy; methotrexate; uterine artery embolization.

Summary. Background. Cervical pregnancy is a rare form of ectopic pregnancy, and the most effective method of its treatment is still under investigation. We would like to call attention to selective uterine artery embolization as an effective modern treatment method.

Case. A patient with suspected cervical pregnancy and 7-week amenorrhea was admitted to the hospital after unsuccessful use of emergency contraception. Transvaginal ultrasound showed gestational sack located 11 mm from the external cervical os. Crown-rump length was 11.2 cm, and the fetal heartbeat was present. The level of serum chorionic gonadotropin was 31 930 U/L. Treatment with systemic methotrexate was unsuccessful, and unilateral uterine artery embolization was performed followed by dilatation and curettage of the cervical canal. Three days after the procedure, sonographic examination showed contracted cervical canal. After a period of two months, normal uterine artery flow was registered by Doppler ultrasonography on both sides.

Conclusion. Uterine artery embolization in case of cervical pregnancy reduces the risk of bleeding and can be the method of choice when treatment with methotrexate fails. Unilateral embolization is effective when angiography shows unequal disposition of the arterial connections supplying the embryo.

Correspondence to V. Tarasevičienė, Department of Obstetrics and Gynecology, Kaunas University of Medicine, Eivenių 2, 50009 Kaunas, Lithuania. E-mail: viktorija.taraseviciene@gmail.com

Received 14 June 2007, accepted 9 November 2007