Uterine artery embolization in the management of vaginal bleeding from cervical pregnancy: A case series

OBJECTIVE: To report our experience of selective embolotherapy in 8 consecutive patients with cervical pregnancy (CxP) presenting with vaginal bleeding. STUDY DESIGN: A total of 9 selective pelvic embolization procedures were performed on 8 patients with CxP, either as an emergency, for control of vaginal hemorrhage (2 patients), or on a nonemergency basis, for moderate vaginal bleeding (6 patients). One patient underwent 2 embolization procedures, once for each indication. RESULTS: Successful hemostasis was obtained in both emergency cases. In 3 of the nonemergency cases, the CxP rapidly resolved. In the 3 other nonemergency cases, elevated β-human chorionic gonadotropin levels persisted, with a new episode of vaginal bleeding in 2 patients 2 and 4 weeks later, respectively; the bleeding resolved after the administration of methotrexate. Significant vaginal hemorrhage occurred 4 weeks later in the third patient and responded to repeat embolotherapy. One patient required a blood transfusion. The uterus was preserved in all 8 patients. One patient was lost to follow-up, but normal menses resumed in all 7 of the others; and 2 patients had subsequent successful pregnancies. CONCLUSION: Embolotherapy is effective in treating and preventing vaginal hemorrhage associated with CxP while allowing uterine preservation. Along with methotrexate and other medical treatment of CxP, we recommend routine use of embolization in patients presenting with vaginal bleeding.