Purpose: To review and share our center experience with combined endovascular-pharmacologic treatment of non-tubal ectopic pregnancy with positive fetal cardiac activity.
Materials and Methods: We conducted a retrospective study on all cases of non-tubal ectopic pregnancy with positive fetal cardiac activity treated with uterine artery embolization via local methotrexate (MTX) injection and subsequent systemic MTX treatment in our university-affiliated, tertiary medical center from January 2000 to March 2014. Data on patient demographics, endovascular procedure, imaging, adverse effects and follow-up were retrieved from the patient’s computerized medical files.
Results: The study group comprised 14 women. Treatment was successful in 93% of cases with beta-human chorionic gonadotropin returning to undetectable levels within 12-147 days (mean, 61.2 days). In one woman with cervical pregnancy, fetal cardiac activity remained two days after protocol completion. Mild adverse effects included abdominal discomfort (30%), groin or leg pain (11%), and local puncture site irritation (10%). No serious adverse events were observed. Among 8 women who stated that they were interested in becoming pregnant, 6 (75%) had a subsequent pregnancy, although 2 of them (30%) had spontaneous abortions.
Conclusion: Intra-arterial MTX followed by temporary bilateral uterine artery embolization combined with systemic MTX treatment, is a safe, effective and fertility preserved technique in the management of advanced non-tubal ectopic pregnancy with positive fetal cardiac activity.
