Combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection for conservative management of cervical pregnancy

Study Objective. To evaluate whether the combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection may eliminate unexpected and uncontrolled massive uterine bleeding without compromising future fertility in women with cervical pregnancy. Design. Prospective study (Canadian Task Force classification II-2). Setting. Tertiary-care university hospital. Patients. Three women. Intervention. Laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection. Measurements and Main Results. Three cases of cervical pregnancy were diagnosed by ultrasound at 6, 7, and 9 weeks' gestation. After treatment, all three women experienced intermittent vaginal bleeding, but none required transfusion. Levels of β-human chorionic gonadotropin returned to normal within 7 weeks, and patients resumed normal menstruation within 11 weeks after treatment. One woman conceived an intrauterine pregnancy 3 months after restoration of normal menstruation, and was delivered at term. Conclusion. The combination of laparoscopic bilateral uterine artery ligation and intraamniotic methotrexate injection appears to be effective in preventing unexpected massive uterine bleeding in patients with cervical pregnancy, and does not compromise future fertility.