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Semin intervent Radiol 2023; 40(04): 357-361
DOI: 10.1055/s-0043-1770712
Review Article

Local Methotrexate Plus Uterine Artery Embolization for High-Risk Interstitial Ectopic Pregnancy

Mark Mikhitarian
1   Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
William Goodnight III
2   Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
,
Nicole Keefe
1   Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Abstract

Interstitial ectopic pregnancy involves the interstitial portion of the fallopian tube and is among the most hazardous of all ectopic pregnancies, with the highest risk of uterine rupture and maternal mortality. Unlike tubal ectopic pregnancy, management of interstitial pregnancy is not well standardized. Systemic methotrexate (MTX) and surgical resection are the primary treatment options; however, failure rates and risk of bleeding remain high. Alternative minimally invasive techniques have been described—including uterine artery embolization (UAE) and local injection of MTX or potassium chloride—and may confer improved success rates. We report a case of a high-risk 28-year-old female with an interstitial ectopic pregnancy successfully treated with combined local injection of MTX plus UAE. We describe our technique and the unique medical management in the setting of a known bleeding disorder.

Keywords

interstitial ectopic pregnancy - uterine artery embolization - methotrexate - interventional radiology


Publication History

Article published online:
10 August 2023

© 2023. Thieme. All rights reserved.

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