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Mosconi C, Crocetti L, Bruno A, Candita G, Cappelli A, Perrone O, Golfieri R, Cioni R. Scar Pregnancy and Extrauterine Implants. Semin Ultrasound CT MR 2021; 42:46-55. [PMID: 33541589 DOI: 10.1053/j.sult.2020.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cesarean scar pregnancy (CSP) is a rare occurrence consisting in the implantation of the embryo within the myometrium of a prior cesarean delivery scar. The CSP could be a dangerous condition for women because of the related complications such as placenta previa or accreta, uterine rupture, and hemorrhage. Therefore, early diagnosis and rapid treatment are crucial. Extrauterine implants or ectopic pregnancy (EP) consists in the implantation of an embryo in a site other than the endometrium of the uterine cavity. It occurs in 1%-2% of all reported pregnancies. The most common extrauterine location is the fallopian tube, which represents 96% of cases. The diagnosis of CSP and EP is based on history, clinical examination, levels of serum β-human chorionic gonadotropin (β-hCG), and ultrasonography findings. In last 20 years, new treatments were developed, varying from medical management, minimally invasive surgical approach and local treatment including systemic or local infusion of metotrexate (MTX), and uterine artery embolization (UAE). UAE has been used widely to control hemorrhage and preserve the uterus and it is considered an affective adjuvant treatment of CSP and EP, especially associated with other therapies.
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Affiliation(s)
- Cristina Mosconi
- Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine - DIMES, Alma Mater Studiorum - University of Bologna, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Laura Crocetti
- Diagnostic and Interventional Radiology, Imaging Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Antonio Bruno
- Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine - DIMES, Alma Mater Studiorum - University of Bologna, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Gianvito Candita
- Diagnostic and Interventional Radiology, Imaging Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alberta Cappelli
- Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine - DIMES, Alma Mater Studiorum - University of Bologna, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Orsola Perrone
- Diagnostic and Interventional Radiology, Imaging Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Specialized, Diagnostic and Experimental Medicine - DIMES, Alma Mater Studiorum - University of Bologna, University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Roberto Cioni
- Diagnostic and Interventional Radiology, Imaging Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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Li Z, Xu W, Hu B, Li M, Zhou J, Ni C. Uterine artery embolization in association with methotrexate infusion for the treatment of tubal ectopic pregnancy. J Interv Med 2019; 1:182-187. [PMID: 34805848 PMCID: PMC8586582 DOI: 10.19779/j.cnki.2096-3602.2018.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate the safety, feasibility, and effectiveness of uterine artery embolization in association with methotrexate (MTX) infusion for the treatment of tubal ectopic pregnancy. Methods Fifty-one patients with tubal ectopic pregnancy were referred for interventional management. All patients received super-selective arteriography of the uterine artery, were infused with 50-100 mg methotrexate (MTX) through a catheter, and underwent embolization of the uterine artery with a gel-foam pledge. Clinical presentation, findings of physical examination, β-HCG values, and the size of the ectopic mass were documented for comparison. The concentration of MTX in blood was evaluated at 0.5, 6, 12, 24, 36, and 48 hours after the procedure. Results Forty-seven out of the 51 patients had clinical resolution of their tubal pregnancy (92.2%). The average time for the β-HCG value to decrease and come back to normal was 9.16 ± 2.54 days (mean +/- SD). MTX levels in peripheral blood could not be detected for patients who received 50 or 75 mg MTX at 36 hours after the procedure, while the MTX level was 0.01 μmol/L at 48 hours after the procedure for patients who received 100 mg. Out of the 4 cases whose ectopic mass size was ≥5 cm, 3 failed to respond to the treatment; however, those whose ectopic mass size was ≤5 cm responded positively to the treatment, regardless of the β-HCG concentration and abdominal bleeding, except for 1 patient who had to undergo laparoscopy for severe abdominal pain and who showed a reduction in her β-HCG level. Conclusion Uterine artery embolization in association with methotrexate infusion is safe and effective in the treatment of tubal ectopic pregnancy, especially for those women with mild to moderate bleeding, or for those at risk of a major hemorrhage. The selection criterion of mass size >5 cm should, therefore, be carefully considered.
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Affiliation(s)
- Zhi Li
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wenjian Xu
- Department of Obstetrics and Gynecology, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Bo Hu
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Mingming Li
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Jianwei Zhou
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Caifang Ni
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China,Correspondence: Caifang Ni, Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China,
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