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Safety and Efficacy of Uterine Artery Embolization in Ectopic Pregnancies Refractory to Systemic Methotrexate Treatment: A Single-Center Study

Authors
 Joon Ho Kwon  ;  Gyoung Min Kim  ;  Kichang Han  ;  Man Deuk Kim  ;  Jong Yun Won  ;  Do Yun Lee 
Citation
 CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol.40(9) : 1351-1357, 2017 
Journal Title
 CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY 
ISSN
 0174-1551 
Issue Date
2017
MeSH
Adult ; Chorionic Gonadotropin/blood ; Female ; Humans ; Pregnancy ; Pregnancy, Ectopic/blood ; Pregnancy, Ectopic/therapy* ; Retrospective Studies ; Treatment Failure ; Uterine Artery Embolization/adverse effects ; Uterine Artery Embolization/methods* ; Uterine Hemorrhage/therapy
Keywords
Ectopic pregnancy ; Methotrexate ; Serum β-human chorionic gonadotrophin (hCG) ; Uterine artery embolization ; Vaginal bleeding
Abstract
BACKGROUND: To investigate the use of uterine artery embolization (UAE) to manage ectopic pregnancies that are refractory to systemic methotrexate (MTX) therapy and plagued by persistently high serum β-human chorionic gonadotrophin (hCG) levels and vaginal bleeding. The safety and efficacy of UAE were addressed. MATERIALS AND METHODS: A retrospective review was conducted for thirteen patients (mean age 35.2 years; range 28-41 years), who were treated between December 2006 and June 2016. Each was subjected to UAE due to persistently high serum β-hCG levels and vaginal bleeding after systemic MTX therapy for ectopic pregnancy. Embolic agents used were non-spherical polyvinyl alcohol or gelatin sponge particles. Post-treatment follow-up was performed by monitoring for clinical signs of vaginal bleeding, serum β-hCG testing, and transvaginal US. Outcomes were technical success, clinical success, and complications. RESULTS: Median follow-up period was 172.5 days (range 30-600 days). Technical success was achieved in all 13 patients (100%). In 10 patients, vaginal bleeding resolved after one UAE attempt (clinical success 76.0%). Rebleeding in other three (23.1%) was controlled through repeat UAE. Seven patients (53.8%) had additional dilatation and curettage to remove gestational sac remnants. All ectopic pregnancies were successfully treated by UAE, with normalization of serum β-hCG levels during follow-up monitoring (P = 0.01). Uterine preservation was achieved in all 13 patients, without major procedural complications. CONCLUSION: UAE appears safe and effective as treatment of ectopic pregnancies marked by persistently high serum β-hCG levels and vaginal bleeding after systemic MTX treatment.
Full Text
https://link.springer.com/article/10.1007%2Fs00270-017-1664-7
DOI
10.1007/s00270-017-1664-7
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Joon Ho(권준호) ORCID logo https://orcid.org/0000-0002-6178-7252
Kim, Gyoung Min(김경민) ORCID logo https://orcid.org/0000-0001-6768-4396
Kim, Man Deuk(김만득) ORCID logo https://orcid.org/0000-0002-3575-5847
Won, Jong Yun(원종윤) ORCID logo https://orcid.org/0000-0002-8237-5628
Lee, Do Yun(이도연)
Han, Ki Chang(한기창) ORCID logo https://orcid.org/0000-0002-9701-9757
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160793
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