ArticleBMC pregnancy and childbirth2026
Uterine artery embolization with or without methotrexate followed by D&C versus D&C alone for cervical pregnancy: a retrospective cohort study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- The Role of Interventional Radiology in the Diagnosis and Treatment of Gynecological Conditions.Tomography (Ann Arbor, Mich.) · 2026Review
- Cervical and Cesarean Scar Pregnancy in One Patient: A Sequential Case with Literature Review.Journal of clinical medicine · 2026Review
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6 authors.
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Abstract
backgroundCervical 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.
methodsThis 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.
resultsDespite 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.
conclusionFor 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.
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