Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester

Abstract

Uterine artery chemoembolization for management of unruptured interstitial pregnancy diagnosed in the early first trimester Akihiro Takeda1,*, Shohei Iyoshi1 , Satoshi Tamauchi1 , Wataru Koike2 1Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, 507-8522 Gifu, Japan 2Department of Diagnostic Radiology, Gifu Prefectural Tajimi Hospital, Tajimi, 507-8522 Gifu, Japan *Correspondence: gyendoscopy@gmail.com (Akihiro Takeda) Academic Editor: Antonio Simone Laganà Submitted: 5 July 2021 Revised: 13 August 2021 Accepted: 18 August 2021 Published: 12 January 2022 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