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Background <p>Cervical pregnancy (CP) is a rare but life-threatening ectopic gestation with high risk of catastrophic hemorrhage during evacuation. Uterine artery embolization (UAE) combined with dilation and curettage (D&amp;C) has been proposed as a fertility-sparing approach, but its comparative effectiveness against D&amp;C alone remains insufficiently evaluated across multidimensional outcomes.</p> Methods <p>This retrospective cohort study included 67 women with first-trimester CP diagnosed between September 2020 and June 2025. Based on shared decision-making, 43 patients received UAE with or without methotrexate (MTX) followed by D&amp;C, while 24 underwent D&amp;C alone. The primary outcome was time to undetectable serum β-human chorionic gonadotropin (β-hCG). Secondary outcomes included intraoperative blood loss, composite treatment success (defined as no transfusion, no ICU admission, no retained products, and no re-intervention), menstrual recovery, and hospitalization costs.</p> Results <p>Despite presenting with more advanced disease (higher preoperative β-hCG: 25,521 vs. 4,472 mIU/mL; larger gestational sacs; more fetal cardiac activity), the UAE (± MTX) + D&amp;C group achieved significantly faster biochemical resolution (24.6 vs. 30.7 days to undetectable β-hCG, <i>p</i> &lt; 0.001), markedly reduced intraoperative blood loss (7 [6–10] vs. 47 [35.5–57] mL, <i>p</i> &lt; 0.001), and higher composite treatment success (97.7% vs. 79.2%, <i>p</i> = 0.038). After adjustment for baseline confounders (log₁₀-transformed preoperative β-hCG, gestational age, fetal cardiac activity, and sac diameter), UAE-based therapy remained independently associated with accelerated β-hCG decline (adjusted hazard ratio [aHR] = 4.67, 95% CI: 1.63–13.51, <i>p</i> = 0.004). Results were consistent across sensitivity analyses including a parsimonious model and IPTW. No patient in the UAE (± MTX) + D&amp;C group required transfusion, ICU admission, or re-intervention. However, UAE was associated with transient post-embolization syndrome (62.8% vs. 12.5%, <i>p</i> &lt; 0.001), delayed menstrual recovery (46 vs. 35 days, <i>p</i> = 0.002), and higher hospitalization costs (CNY [Chinese Yuan] 16,923 vs. 5,933, <i>p</i> &lt; 0.001). Subgroup analysis showed that adjunctive MTX further accelerated β-hCG decline and mass resolution in patients with higher disease burden.</p> Conclusion <p>For CP, UAE-based therapy followed by D&amp;C demonstrated improved efficacy and enhanced perioperative safety compared to D&amp;C alone, even in more advanced cases, at the expense of transient menstrual delay and increased cost. A risk-stratified approach is recommended: UAE (± MTX) + D&amp;C for high-risk pregnancies, and D&amp;C alone only for low-risk cases in settings with immediate interventional backup.</p>

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Uterine artery embolization with or without methotrexate followed by D&C versus D&C alone for cervical pregnancy: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年3月6日

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  • Jianfeng He,
  • Xiaoqing Liu,
  • Rong Zhang,
  • Tianhong Cai,
  • Kai Chen,
  • Tenghui Zhan

摘要

Background

Cervical pregnancy (CP) is a rare but life-threatening ectopic gestation with high risk of catastrophic hemorrhage during evacuation. Uterine artery embolization (UAE) combined with dilation and curettage (D&C) has been proposed as a fertility-sparing approach, but its comparative effectiveness against D&C alone remains insufficiently evaluated across multidimensional outcomes.

Methods

This retrospective cohort study included 67 women with first-trimester CP diagnosed between September 2020 and June 2025. Based on shared decision-making, 43 patients received UAE with or without methotrexate (MTX) followed by D&C, while 24 underwent D&C alone. The primary outcome was time to undetectable serum β-human chorionic gonadotropin (β-hCG). Secondary outcomes included intraoperative blood loss, composite treatment success (defined as no transfusion, no ICU admission, no retained products, and no re-intervention), menstrual recovery, and hospitalization costs.

Results

Despite presenting with more advanced disease (higher preoperative β-hCG: 25,521 vs. 4,472 mIU/mL; larger gestational sacs; more fetal cardiac activity), the UAE (± MTX) + D&C group achieved significantly faster biochemical resolution (24.6 vs. 30.7 days to undetectable β-hCG, p < 0.001), markedly reduced intraoperative blood loss (7 [6–10] vs. 47 [35.5–57] mL, p < 0.001), and higher composite treatment success (97.7% vs. 79.2%, p = 0.038). After adjustment for baseline confounders (log₁₀-transformed preoperative β-hCG, gestational age, fetal cardiac activity, and sac diameter), UAE-based therapy remained independently associated with accelerated β-hCG decline (adjusted hazard ratio [aHR] = 4.67, 95% CI: 1.63–13.51, p = 0.004). Results were consistent across sensitivity analyses including a parsimonious model and IPTW. No patient in the UAE (± MTX) + D&C group required transfusion, ICU admission, or re-intervention. However, UAE was associated with transient post-embolization syndrome (62.8% vs. 12.5%, p < 0.001), delayed menstrual recovery (46 vs. 35 days, p = 0.002), and higher hospitalization costs (CNY [Chinese Yuan] 16,923 vs. 5,933, p < 0.001). Subgroup analysis showed that adjunctive MTX further accelerated β-hCG decline and mass resolution in patients with higher disease burden.

Conclusion

For CP, UAE-based therapy followed by D&C demonstrated improved efficacy and enhanced perioperative safety compared to D&C alone, even in more advanced cases, at the expense of transient menstrual delay and increased cost. A risk-stratified approach is recommended: UAE (± MTX) + D&C for high-risk pregnancies, and D&C alone only for low-risk cases in settings with immediate interventional backup.