Open Journal of Obstetrics and Gynecology, 2013, 3, 711-716 OJOG
http://dx.doi.org/10.4236/ojog.2013.310131 Published Online December 2013 (http://www.scirp.org/journal/ojog/)
Conservative management of cervical pregnancy: The
utility of methotrexate treatment and uterine artery
embolization
Hisashi Masuyama, Seiji Inoue, Etsuko Nobumoto, Kei Hayata, Tomonori Segawa, Yuji Hiramatsu
Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science,
Okayama, Japan
Received 3 November 2013; revised 24 November 2013; accepted 1 December 2013
Copyright © 2013 Hisashi Masuyama et al. This is an open access article distributed under the Creative Commons Attribution Li-
cense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In
accordance of the Creative Commons Attribution License all Copyrights © 2013 are reserved for SCIRP and the owner of the intel-
lectual property Hisashi Masuyama et al. All Copyright © 2013 are guarded by law and by SCIRP as a guardian
ABSTRACT
The aim of this retrospective case series report is to
evaluate systemic methotrexate therapy in conjunc-
tion with uterine artery embolization (UAE) in the
conservative management of cervical pregnancy. We
examined clinical presentations, treatments, and the-
rapeutic outcomes in fifteen patients with a cervical
pregnancy who wished for preservation of fertility,
treated at Okayama University Hospital between
1998 and 2 012. Twelve pa tients received systemic me-
thotrexate including five treated with UAE. One was
treated with UAE alone. Two patients received nei-
ther UAE nor methotrexate because of a low human
chorionic gonadotropin (hCG) level and poor blood
flow around the gestational sac (GS). An increased
GS size and the elevated hCG level during metho-
trexate therapy might be risk factors for emergent
UAE. Two of six patients treated with UAE had
subsequent confirmed viable pregnancies. In patients
with a cervical pregnancy, methotrexate therapy in
combination with UAE can be considered as an op-
tion before performing a hysterectomy with suitable
counseling about the risk of loss of fertility. Careful
observation of the GS size and hCG level during
methotrexate therapy might be important for mana-
gement.
Keywords: Cervical Pregnancy; Methotrexate; Uterine
Artery Embolization; Dilatation and Curettage; Human
Chorionic Gonadotropin
1. INTRODUCTION
Cervical pregnancy is a rare but potentially life-threatening
medical condition and has been reported at an incidence of
1 in 8000 - 18000 deliveries, but the incidence is increasing
as a result of assisted reproductive technology [1,2]. Thus,
in vitro fertilization and embryo transfer (IVF-ET) has been
associated with an increased incidence of cervical preg-
nancy [3,4]. In the past, 60% of cases of cervical preg-
nancy were diagnosed at an advanced stage in which life-
threatening hemorrhage occurred after a dilatation and
curettage (D&C) or a suspected spontaneous abortion [5].
Such cases often resulted in the need for a hysterectomy
and loss of the patient’s fertility. The use of curettage with a
Foley catheter tamponade or placement of a Shirodkar cer-
clage has also been reported for hemorrhage associated
with a cervical pregnancy [6-9], but these procedures have
not been established as safe.
Recently, the application of first-trimester transvaginal
ultrasonography has led to improvements in the early diag-
nosis of cervical pregnancy, thereby assisting in conser-
vative and fertility-preserving treatment [10,11]. Since
Farabow et al. introduced systemic methotrexate (MTX)
treatment for cervical pregnancy [12], MTX treatment has
become an established alternative to surgical therapy
[13-15]. Moreover, uterine artery embolization (UAE) has
been widely used as a highly effective technique for con-
trolling acute and chronic genital bleeding [16-18]. There
have been sporadic reports of cases of cervical pregnancy
with vaginal bleeding that were controlled by UAE and the
administration of MTX to preserve fertility and control
bleeding [19]. The risks of embolotherapy include uterine
infarction or ischemia and necrosis; however, the majority
of patients tolerate the procedure well [20,21]. Combined
therapy with MTX has also been used and has been
recommended by reports of UAE as an initial therapy to
treat patients with a cervical pregnancy [22,23].

H. Masuyama et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 711-716 712
Here we report on 15 patients with a cervical pregnancy,
who wished for minimally invasive intervention and/or the
preservation of their fertility. We applied conservative
management with MTX therapy in combination with UAE.
We have examined our reports of clinical presentations,
treatments and therapeutic outcomes to evaluate our con-
servative management for patients with a cervical preg-
nancy. Laboratory values and demographic information
have been compared and follow-up pregnancy information
has been reported, when available. The aim of this re-
trospective case series report is to demonstrate that syste-
matic MTX therapy combined with UAE is a good clinical
option for the conservative management of patients with a
cervical pregnancy.
2. MATERIALS AND METHODS
Seventeen Japanese women with a suspected cervical
pregnancy who were referred to the Department of Obs-
tetrics and Gynecology, Okayama University Hospital,
Japan, from 1998 to 2012 were included in this study.
The study protocol was approved by the institutional
review board of Okayama University Graduate School
of Medicine, Dentistry and Pharmaceutical Science.
Cervical pregnancies were diagnosed by transvaginal
ultrasound as described previously [10]. Data were
collected through paper chart reviews and through a
review of electronic medical records. Clinical data and
ultrasonographic findings were recorded, including
maternal age, reproductive history, gestational age (GA),
mean gestational sac (GS) diameter, size of the embryo,
and fetal heartbeat. Our conservative management for
patients who desire preservation of their fertility is
outlined in Figure 1. Systematic MTX (50 mg/m2) was
administered intramuscularly every 10 days along with
a follow up of serum human chorionic gonadotropin
(hCG) levels and blood flow around the GS. Ultra-
sound-guided injections of MTX (50 mg) into the GS
Cervicalpregnancy
Wishforco nservat i vemanagement
Massivehem o rrhage
‐+
MTXtherapy
Bloodflow–or?? Massivehemorrh ageor
Nochange ofbloodflow
UAE
D&C
Conservative
Informe dco n sen t
Conservative
Informedcho ice
Informedcho ice
Transvaginalultrasonography
SerumhCG level,(MRI)
Figure 1. Flowchart of the conservative management for cer-
vical pregnancy.
was also considered when there was a positive fetal
heartbeat, a serum hCG level >10000 IU/L, a pregnancy
of >9 gestational weeks or a fetal crown-rump length of
>10 mm.
Uterine artery embolization procedures were per-
formed by qualified interventional radiologists using
gelfoam particles through the right common femoral
artery access and were performed on bilateral uterine
arteries in all cases. The decision to perform UAE was
made on a per-case basis; however, all patients present-
ing with massive hemorrhage were treated in this way.
All values are expressed as the mean ± standard
deviation (SD). Demographic and laboratory data were
compared using Fisher’s exact test for all categorical
variables and mean values were compared using the
Kruskal-Wallis nonparametric analysis of variance and
Mann-Whitney nonparametric U test. Statistical analy-
sis was performed using SPSS software version 20.0
(SPSS Inc., Chicago, IL, USA) and P < 0.05 was con-
sidered statistically significant.
3. RESULTS
Seventeen cases of cervical ectopic pregnancy were
diagnosed at our institution during the study period. One
patient had a heterotopic pregnancy that involved both
cervical and intrauterine gestations. Another patient had
no wish for conservative treatment. The remaining 15
cases were considered for the study (Table 1). Six of
these patients were treated with UAE, and of these, five
also received MTX. One patients had active vaginal
bleeding 67 days after the first UAE was controlled
successfully by additional UAE. The other seven patients
received MTX alone. Two patients received neither UAE
nor MTX because of a low hCG level and poor blood
flow around the GS. Two patients with high serum hCG
levels and positive fetal heartbeats also received local
MTX injection into the GS together with systematic
MTX administration. Forty percent of the study cases
(6/15) had a history of at least one induced abortion and
assisted reproduction techniques were used in eight cases
including six cases of IVF-ET. Six patients were nul-
liparous.
All patients with a cervical pregnancy confirmed by
ultrasound were admitted to our hospital for treatment.
According to our management protocol for cervical
pregnancy (Figure 1), MTX therapy was started imme-
diately except for patients who required emergency UAE
because of a massive hemorrhage. First, we divided the
patients into two groups according to the median GA
value (45 days) to examine whether GA affected the
therapy. There was a significant difference in the serum
hCG level between the two groups and all cases with
massive bleeding were included in the long GA group
(Table 2(a)). The median value of GS size (13 mm) was

H. Masuyama et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 711-716 713
Table 1. Characteristics of patients with a cervical pregnancy.
Case Age Gravida para antificial
abortion Infertility GA (days)
GS
(mm)FHM Blood flow around GS
hGG level
(mIU/mL)
genital
bleeding
No. of
MTX UGE Other treatment
1 36 1 0 1 – 77 80 + + 64030 Moderate3 + MTX
injection, D&C
2 22 2 0 1 – 42 28 + + 4015 Small 2 + D&C
3 38 1 0 0 IVF-ET 48 9.9– ± 8123 Small 2 - -
4 40 1 0 1 IVF-ET 41 10.6+ + 4133 Small 4 + -
5 23 2 0 1 – 52 18 + ± 16967 - 2 - -
6 34 0 0 0 IVF-ET 42 8.9+ + 4665 - 2 + Aspiration of GS
7 40 0 0 0 – 57 7.5– – 868 - 2 - -
8 28 0 0 0 – 38 11.7+ + 11271 - 2 - MTX injection
9 32 5 1 4 - 56 10.5- + 9897 Heavy0 + -
10 40 2 1 0 AIH 51 21 + ± 16131 - 0 - -
11 37 2 1 0 IVF-ET 52 19 – + 41261 Heavy3 2x D&C
12 30 0 0 0 – 36 17.1– – 6056 Moderate2 - -
13 41 2 0 2 Clomid 41 16 – – 1191 Small 0 - -
14 31 0 0 0 Clomid 38 7 – ± 2095 Small 1 - -
15 39 0 0 0 IVF-ET 45 13 + + 13575 small 8 - D&C
GA: gestational age, GS: gestational sac, FHM: fetal heart movement, hCG: human chorionic gonadotropin, MTX: methotrexate, UAE: uterine artery emboli-
zation, D&C: dilatation and curettage.
Table 2. Comparison between groups with early and late gestational age (GA) (a), small and large gestational sac (GS) (b) and low
and high serum hCG levels (c).
(a)
GA (days) Case number GS(mm) FHM Blood flow around GShCG level (mIU/mL)Massive bleeding MTX UAED&C
<45 7 14.2 ± 7.1 4 5 4775 ± 3288 0 6 3 1
≥45 8 22.4 ± 23.8 4 7 21357 ± 20875* 2 6 3 3
(b)
GS (mm) Case number GA (days) FHM Blood flow around GShCG level (mIU/mL)Massive bleeding MTX UAED&C
<13 7 45.7 ± 8.1 3 6 5864 ± 3962 1 6 3 0
≥13 8 49.5 ± 12.5 5 6 20403 ± 21575* 1 6 3 4
(c)
hCG level (mIU/mL) Case number GA (days) GS (mm)FHM Blood flow around GSMassive bleeding MTX UAED&C
<8123 7 42.4 ± 6.8 13.6 ± 7.53 4 0 6 3 1
≥8123 8 52.4 ± 11.4*22.9 ± 23.45 8* 2 6 3 3
*P < 0.05, mean ± SD, GA: gestational age, GS: gestational sac, FHM: fetal heart movement, hCG: human chorionic gonadotropin, MTX: methotrexate, UAE:
uterine artery embolization, D&C: dilatation and curettage.
also used to divide the patients into two groups. The
serum hCG level was significantly higher and all patients
who required D&C were included in the large GS group
(>13 mm; Table 2(b)). Two groups were also evaluated
using the median value of hCG level (8123 mIU/mL).
There were significant differences in blood flow around
the GS, but there was no significant difference in the
incidence of D&C and the requirement for UAE in the
high hCG group (Table 2(c)). We also examined the
patients who underwent UAE. The GS size and serum
hCG level at admission in the UAE group were higher
than in the group without UAE, but this was not sig-
nificant statistically because some patients with a small
GS and/or low hCG level required UAE because of a
moderate or massive hemorrhage (Table 3(a)). In ad-
dition, clinical data on when UAE was done in the UAE
cases are summarized in Table 3(b). All patients with
emergency UAE except for two with UAE at admission
for massive hemorrhage had an increased and/or large
GS size and/or elevation of serum hCG levels at UAE
compared with those seen at admission.
Of the six patients who underwent UAE, two sub-
sequently had confirmed viable pregnancies. Of these,
one pregnancy resulted in a preterm delivery at 31

H. Masuyama et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 711-716 714
Table 3. Comparison between groups with and without UAE (a) and characteristics of cases with UAE (b).
(a)
UAE Case number GA (days) GS (mm) FHMBlood flow around GShCG level (mIU/mL) MTXD&C
- 9 45.1 ± 7.4 [36 - 57] 13.5 ± 4.9 [7.0 - 21.0]4 6 8475 ± 6345 [868 - 16967] 7 1
+ 6 51.7 ± 13.9 [41 - 77] 26.2 ± 27.3 [8.9 - 80.0]4 6 21334 ± 25395 [4015 - 64030] 5 3
(b)
Case GS (mm) FHM Blood flow around GS hCG level (mIU/mL) Bleeding situation
1 80/58 +/− +/− 64030/25 at D&C after MTX 3 courses
2 28/64 +/− +/+ 4015/422 at D&C after MTX 2 courses
4 11/13 +/− +/+ 4133/16055 after MTX 1 course
6 9/50 +/− +/+ 4665/1708 after MTX 2 courses
10 10 − + 9897 at admission
12 19/12 − + 41261/122 at admission and after MTX 3 courses
GA: gestational age, GS: gestational sac, FHM: fetal heart movement, hCG: human chorionic gonadotropin, MTX: methotrexate, UAE: uterine artery emboli-
zation, D&C: dilatation and curettage, GS size: at admisssion/at UAE.
weeks’ gestation because of preterm labor and premature
rupture of membranes and the other patient had a spon-
taneous vaginal term delivery with placenta accreta.
None of the patients required hysterectomy.
4. DISCUSSION
In this study, we analyzed the outcomes for 15 patients
with a cervical pregnancy who wished for minimally
invasive treatment to preserve their fertility under our
protocol of conservative management for cervical
pregnancy (Figure 1). Of this series, 12 patients re-
ceived systemic MTX administration including seven
with MTX alone and five were also treated with UAE.
The other patient was treated with UAE alone. Two
patients received neither UAE nor MTX because of a
low hCG level and poor blood flow around the GS.
Forty percent of the study patients had a history of at
least one induced abortion, and assisted reproductive
techniques were used in eight cases including six cases
of IVF-ET. An increased GS size and an elevated hCG
level during MTX therapy might be risk factors for
emergency UAE. Of the six patients who underwent
UAE, two subsequently had confirmed viable preg-
nancies.
MTX treatment has been used successfully for treat-
ing cervical pregnancies and has become the first line
therapy for stable patients [12-15]. However, additional
therapies were often required for this treatment. We
found here that the group of patients with a high hCG
level (>8123 mIU/mL) included all with a massive
hemorrhage and a higher requirement for D&C, but
there were no significant differences in the requirement
for UAE. This elevated hCG level is consistent with a
previous report [24]. Another report indicated that UAE
should be applied after systematic MTX therapy and—
if a fetal heart beat is present—lethal intraamniotic
KCL injection should be considered in cases with very
high hCG level (>34,000 mIU/mL) [25]. Conversely,
the hCG level at admission could not predict the
requirement for UAE in our study because we observed
that the patients with low hCG level after MTX therapy
as well as with low initial level needed emergency UAE
for a moderate hemorrhage. However, most patients
requiring emergency UAE had a large GS and/or
elevation of serum hCG levels at UAE compared with
at admission, suggesting that careful observation might
be important for conservative management.
Previous reports have suggested that UAE alone may
be insufficient to treat a cervical pregnancy effectively
and that concurrent medical therapy might be indicated
[23,25]. In our study, only one patient had a spon-
taneous abortion after UAE caused by a heavy hemorr-
hage. In all of our patients, UAE was effective in stopp-
ing active vaginal bleeding and preserving the uterus as
reported previously [17,18,26]. However, one of our pa-
tients had active vaginal bleeding 67 days after the first
UAE; this was controlled successfully by additional
UAE and emergency D&C of the cervical canal after
the second UAE.
Viable pregnancies have been reported after UAE
[25,27]. In our study, two patients subsequently had
viable pregnancies although assisted reproduction tech-
niques—one of the risk factors for cervical preg-
nancy—were used in eight cases including six cases of
IVF-ET. Despite these observations, patients seeking
fertility preservation who may undergo UAE should
receive adequate prior counseling according to Ame-
rican college of obstetrics and gynecology (ACOG) re-
commendations [28]. Thus, the use of UAE for cervical

H. Masuyama et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 711-716 715
pregnancy can be considered among patients desiring
future childbearing, but further studies are needed to
elucidate the effect of UAE on pregnancy outcomes.
5. CONCLUSION
In conclusion, MTX therapy in combination with UAE
can be considered as an option before hysterectomy,
with counseling about the risk of loss of fertility in pa-
tients with cervical pregnancy. Careful observations of
GS size and hCG levels during MTX therapy might be
important for management. Because more cases are
being detected earlier with first-trimester ultrasono-
graphy and with the increased incidence with assisted
reproductive technology, cervical pregnancy is becom-
ing a more commonly encountered clinical situation.
The use of MTX in combination with UAE for the con-
servative management of a cervical pregnancy in pa-
tients desiring to preserve their fertility should be con-
sidered strongly.
REFERENCES
[1] Parente, J.T., Ou, C.S., Levy, J. and Legatt, E. (1983) Cer-
vical pregnancy analysis: A review and report of five ca-
ses. Obstetrics & Gynecology, 62, 79-82.
[2] Ginsburg, E.S., Frates, M.C., Rein, M.S., Fox, J.H., Hor-
nstein, M.D. and Friedman, A.J. (1994) Early diagnosis
and treatment of cervical pregnancy in an in vitro fertili-
zation program. Fertility and Sterility, 61, 966-969.
[3] Bayati, J., Garcia, J.E., Dorsey, J.H. and Padilla, S.L.
(1989) Combined intrauterine and cervical pregnancy
from in vitro fertilization and embryo transfer. Fertility
and Sterility, 51, 725-727.
[4] Bennett, S., Waterstone, J., Parsons, J. and Creighton, S.
(1993) Two cases of cervical pregnancy following in vi-
tro fertilization and embryo transfer to the lower uterine
cavity. Journal of Assisted Reproduction and Genetics,
10,100-103. http://dx.doi.org/10.1007/BF01204450
[5] Cunningham, F.G., Gant, N.F., Leveno, K.J., Gilstrap,
L.C., Hauth, J.C. and Wenstrom, K.D. (2001) Cervical
pregnancy. Williams Obstetrics. 21st Edition, McGraw-
Hill, New York, 251-253.
[6] Ratten, G.J. (1983) Cervical pregnancy treated by ligation
of the descending branch of the uterine arteries: Case re-
port. British Journal of Obstetrics and Gynaecology, 90,
367-371.
http://dx.doi.org/10.1111/j.1471-0528.1983.tb08925.x
[7] Nelson, R.M. (1979) Bilateral internal iliac artery ligation
in cervical pregnancy: Conservative of reproductive fun-
ction. American Journal of Obstetrics and Gynecology,
134, 145-150.
[8] Scott, J.W., Diggory, P.L. and Edelman, P.J. (1978) Ma-
nagement of cervical pregnancy with circumsuture and
intracervical obturator. British Medical Journal, 1, 825.
http://dx.doi.org/10.1136/bmj.1.6116.825
[9] Nolan, T.E., Chandler, P.E., Hess, L.W. and Morrison,
J.C. (1989) Cervical pregnancy managed by placement of
a shirodkar cerclage before evacuation: A case report.
Journal of Reproductive Medicine, 34, 69-70.
[10] Raskin, M.M. (1978) Diagnosis of cervical pregnancy by
ultrasound: A case report. American Journal of Obstetrics
and Gynecology, 130, 234-235.
[11] Kung, F.T., Chang, S.Y., Tsai, Y.C., Hwang, F.R., Hsu,
T.Y. and Soong, Y.K. (1997) Subsequent reproduction
and obstetric outcome after methotrexate treatment of cer-
vical pregnancy: A review of original literature and inter-
national collaborative follow-up. Human Reproduction,
12, 591-595.
http://dx.doi.org/10.1093/humrep/12.3.591
[12] Farabow, W.S., Fulton, J.W., Fletcher, V., Velat, C.A.
and White, J.T. (1983) Cervical pregnancy treated with me-
thotrexate. North Carolina Medical Journal, 44, 91-93.
[13] Bakri, Y.N. and Badawi A. (1990) Cervical pregnancy
successfully treated with chemotherapy. Acta Obstetrical
and Gynecological Scandinavia, 69, 655-656.
http://dx.doi.org/10.3109/00016349009028714
[14] Palti, Z., Rosenn, B., Goshen, R., Ben-Chitrit, A. and Ya-
gel, S. (1989) Successful treatment of a viable cervical
pregnancy with methotrexate. American Journal of Ob-
stetrics and Gynecology, 161, 1147-1148.
http://dx.doi.org/10.1016/0002-9378(89)90653-4
[15] Stovall, T.G., Ling, F.W., Smith, W.C., Felker, R., Rasco,
B.J. and Buster, J.E. (1988) Successful nonsurgical treat-
ment of cervical pregnancy with methotrexate. Fertility
and Sterility, 50, 672-674.
[16] Vedantham, S., Goodwin, S.C., McLucas, B., Mohr, G.
(1997) Uterine artery embolization: An underused me-
thod of controlling pelvic hemorrhage. American Journal
of Obstetrics and Gynecology, 176, 938-948.
http://dx.doi.org/10.1016/S0002-9378(97)70624-0
[17] Suzumori, N., Katano, K., Sato, T., Okada, J., Nakanishi,
T. and Muto, D. (2003) Conservative treatment by angio-
graphic artery embolization of an 11-week cervical preg-
nancy after a period of heavy bleeding. Fertility and Ste-
rility, 80. 617-619.
http://dx.doi.org/10.1016/S0015-0282(03)00740-4
[18] Nappi, C., D’Elia, A., Di Carlo, C., Giordano, E., De Pla-
cido, G. and Iaccarino, V. (1999) Conservative treatment
by angiographic uterine artery embolization of a 12 week
cervical ectopic pregnancy. Human Reproduction, 14,
1118-1121.http://dx.doi.org/10.1093/humrep/14.4.1118
[19] Lobel, S.M., Meyerovitz, M.F., Benson, C.C., Goff, B.
and Bengtson, J.M. (1990) Preoperative angiographic ute-
rine artery embolization in the management of cervical
pregnancy. Obstetrics & Gynecology, 76, 938-941.
http://dx.doi.org/10.1097/00006250-199011001-00017
[20] Godfrey, C.D. and Zbella, E.A. (2001) Uterine necrosis
after uterine artery embolization for leiomyoma. Obstet-
rics & Gynecology, 98, 950-952.
http://dx.doi.org/10.1016/S0029-7844(01)01483-1
[21] Pron, G., Bennett, J., Common, A., Sniderman, K., Asch,
M., Bell. S., Kozak, R., Vanderburgh, L., Garvin, G., Si-
mons, M., Tran, C., Kachura, J. and Ontario UFE Colla-
borative Group. (2003) Technical results and effects of
operator experience on uterine artery embolization for fi-

H. Masuyama et al. / Open Journal of Obstetrics and Gynecology 3 (2013) 711-716 716
broids: The Ontario Uterine Fibroid Embolization Trial.
Journal of Vascular and Interventional Radiology, 14,
545-554.
[22] Cosin, J.A., Bean, M., Grow, D. and Wiczyk, H. (1997)
The use of methotrexate and arterial embolization to
avoid surgery in a case of cervical pregnancy. Fertility
and Sterility, 67, 1169-1171.
http://dx.doi.org/10.1016/S0015-0282(97)81459-8
[23] Trambert, J.J., Einstein, M.H., Banks, E., Frost, A. and
Goldberg, G.L. (2005) Uterine artery embolization in the
management of vaginal bleeding from cervical pregnancy:
A case series. Journal of Reproductive Medicine, 50, 844-
850.
[24] Hung, T.H., Shau, W.Y., Hsieh, T.T., Hsu, J.J., Soong,
Y.K. and Jeng, C.J. (1998) Prognostic factors for an un-
satisfactory primary methotrexate treatment of cervical
pregnancy: A quantitative review. Human Reproduction,
13, 2636-2642.
http://dx.doi.org/10.1093/humrep/13.9.2636
[25] Zakaria, M.A., Abdallah, M.E., Shavell, V.I., Berman,
J.M., Diamond, M.P. and Kmak, D.C. (2011) Conserva-
tive management of cervical ectopic pregnancy: Utility of
uterine artery embolization. Fertility and Sterility, 95,
872- 876.
http://dx.doi.org/10.1016/j.fertnstert.2010.12.024
[26] Xu, B., Wang, Y.K., Zhang, Y.H., Wang, S., Yang, L.
and Dai, S.Z. (2007) Angiographic uterine artery em-
bolization followed by immediate curettage: An efficient
treatment for controlling heavy bleeding and avoiding re-
current bleeding in cervical pregnancy. Journal of Ob-
stetrics and Gynecology Research, 33, 190-194.
http://dx.doi.org/10.1111/j.1447-0756.2007.00512.x
[27] Firouznia, K., Ghanaati, H., Sanaati, M., Jalali, A.H. and
Shakiba, M. (2009) Pregnancy after uterine artery em-
bolization for symptomatic fibroids: A series of 15 preg-
nancies. American Journal of Roentgenology, 192 , 1588-
1592. http://dx.doi.org/10.2214/AJR.07.3904
[28] ACOG Committee Opinion, (2004) Uterine artery embo-
lization. Committee on Gynecologic Practice, American
College of Obstetricians and Gynecologists. Obstetrics &
Gynecology, 103, 403-404.