IMR Press / CEOG / Volume 49 / Issue 1 / DOI: 10.31083/j.ceog4901011
Open Access Original Research
Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester
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1 Department of Obstetrics and Gynecology, Gifu Prefectural TajimiHospital, Tajimi, 507-8522 Gifu, Japan
2 Department of Diagnostic Radiology, Gifu Prefectural TajimiHospital, Tajimi, 507-8522 Gifu, Japan

Academic Editor: Antonio Simone Laganà

Clin. Exp. Obstet. Gynecol. 2022 , 49(1), 1; https://doi.org/10.31083/j.ceog4901011
Submitted: 5 July 2021 | Revised: 13 August 2021 | Accepted: 18 August 2021 | Published: 12 January 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Background: With the increased frequency of diagnosis of interstitial pregnancy in the early first trimester, non-surgical management of unruptured interstitial pregnancy has become an important issue. However, management of unruptured interstitial pregnancy by uterine artery chemoembolization (UACE) with dactinomycin has never been evaluated via a case series. Methods: With this aim, a retrospective review of electronic chart records over a five-year period was performed, and a series of cases of unruptured interstitial pregnancy during the first trimester was extracted. Diagnostic procedures included ultrasonography, magnetic resonance imaging (MRI), and laparoscopic examination, if necessary. Conservative treatment regimen included UACE. Additional administration of methotrexate (MTX) was considered when an insufficient decline of serum β-hCG was noted. Clinical characteristics and treatment outcomes are described. Results: Among four women diagnosed with unruptured interstitial pregnancy at six weeks of gestation, one case was managed by laparoscopic cornuostomy due to concerns of rupture after the identification of thinning of the myometrium, whereas the other three cases were initially managed by UACE. One case of proximal interstitial pregnancy was diagnosed solely by MRI, whereas two cases of distal interstitial pregnancy was diagnosed by exploratory laparoscopy. Two cases were successfully managed by UACE alone, whereas one case required additional systemic administration of MTX to achieve resolution of gestational products after UACE. Thereafter, one patient conceived spontaneously and experienced a successful vaginal birth. Conclusions: This small case series emphasizes that UACE is a feasible minimally invasive option for the management of unruptured interstitial pregnancy identified in the early first trimester.

Keywords
Dactinomycin
Diagnostic imaging
Diagnostic laparoscopy
Interstitial pregnancy
Uterine artery chemoembolization
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