The Study Of Clinical Application On Cervical Pregnancy Treated With Uterine Artery Embolization

Objective To investigate the clinical effect and adverse reactions and complications of the uterine artery embolization(UAE) in the treatment of cervical pregnany while compared the effects with the others. Methods 8 women with clinical and ultrasonic diagnosis of cervical pregnancy was treated by selective uterine artery embolization before artifical abortion. UAE has been performed in 2 cases for the emergency control of pelvic hemorrhage, after failure of artifical abortion. Prophylactic UAE has been performed in 6 cases. Eight patients,age ranging from 22 to 35 years,underwent UAE. The procedure was performed with seldinger's technique through the right common femoral artery access under local anaesthesia with 1 percent lidocaine. First, the left uterine artery were selectively catheterized .The left uterine artery and the gestational Sac was clearly show by digital subtraction angiograph(DSA).Subsequently, intraarterial infusion(half of methotrexate,MTX) was performed then embolization of the left uterine artery was performed with Gelfoam pledgets and half MTX remained. Similar procedures were then performed on the right uterine arteries. Microcatheter could be used necessarily during the procedure.1 week after the embolization ,all cases underwent artifical abortion. From February 1999 to October 2004,10 patients with cervical pregnancy, age ranging from 23 to 40 years, were treated by non-UAE. They were treated by intraamniotic methotrexate injection, artifical abortion , medication or a combined therapy. In 6 of the 8 cases were treated by intraamniotic methotrexate injection or by the treatment combined with other treatments. We made a comparison between UAE and non-UAE. We researched on: ①The volume of vaginal bleeding of pre-and-posttreatment. ②β-hCG serum level. ③The parameter of color Doppler ultrasound.④The adverse reactions and complication of UAE for cervical pregnancy. ⑤ After embolization , the time of return of normal menses; subsequent pregnancies. Results ①The successful rate of catheterization and embolization reached 100%.The hemorrhage was controlled effectively by UAE. ②1 week after UAE, quantitative serumβ-hCG declined significantly compared with those before UAE(P<0.01), and the size of the sacs didn't decreased statistically significant compared with those before operation(P>0.05).1 week After UAE , the blood perfusion of the sacs reduced significantly , even disappeared(P<0.01). ③The size of the sacs in 1,2 week after local MTX injection shrunk significantly compared with those before operation(P<0.01) . 1,2 week after UAE, quantitative serum-hCG declined significantly compared with those before operation(P<0.01). 1 ,2 week after local MTX injection , the blood perfusion of the sacs didn't changed significantly(P>0.05). ④Adverse reactions of UAE included postembolization syndrome ( n = 8) ; urinary irritation ( n = 0); and hyporrhea of vagina ( n = 1). Complications of UAE included expelling of cruors per vagina ( n = 1) ; urinary retention ( n = 1). All the above mentioned side effects of UAE recovered to normal after expectant or especial treatment without any sequels left. ⑤After embolization , menses came back mostly within 1-2 months.One year after embolization, l patient who become pregnant and successfully gave birth to a girl at 38 weeks' gestation.She was one year old and healthy so far. Conclusion ①Effective control of severe cervical pregnancy hemorrhage was obtained with UAE in time. Prophylactic UAE could lower risk and complicalion during artifical abortion .②The adverse reactions of UAE are reversible and the complications of UAE are preventable and curable.③Local MTX injection could restrained embryo from developing, but effective control of cervical pregnancy hemorrhage wasn't obtained.