The D&C operation was uncomplicated, and serum ��-hCG level declined to normal within 3 days.The other nine patients received an additional injection of intramuscular MTX (0.5mg/kg) every two days after DSA operation due to these ��-hCG levels continuously kept www.selleckchem.com/products/Trichostatin-A.html high or rebounded after UAE, while including the only patient CP-690550 akt who failed on right uterine arterial embolization just mentioned above. Between them five achieved good outcomes, but despite technical success in uterine artery chemembolization together with systematic MTX administration, persistently growing gestational sacs were found in four patients three weeks later by transvaginal ultrasound. Finally hysterectomy was inevitably performed to remove the fetus. Thus the rate of total uterine preservation was 82.6% (19/23).
DiscussionOriginally uterine artery embolization is an effective treatment for hysteromyoma . For its high technical successful rate, few complications, and capability to preserve fertility, it is also widely used in symptomatic hysteromyoma, arteriovenous malformation, colporrhagia, and various intractable complications following gynecologic operation (certainly including caesarean section). The writer has previously reported its application to one case of intravenous leiomyoma .MTX has direct cytotoxic effect on chorionic villous tissue. After intra-arterial MTX infusion and subsequent transcatheter arteries embolization, blood flow is stemmed in the uteroplacental arteries. As a result adherent placental tissue and trophoblasts in the sectional scar cannot survive due to both drug killing effect and regional ischemia .
That is the reason of uterine artery chemembolization application together.In this case series, all the interventional operations except one were technologically successful, but finally four patients underwent abdominal hysterectomy and lost their uteri. This result is consistent with other studies , suggesting that uterine artery MTX infusion and embolization were not always effective.Several factors are likely to lead to failure to preserve the patients' fertility and need to pay attention in the clinic work.The administration of MTX is the first important factor. Because this kind of pregnancy is surrounded by fibrous scar rather than normally vascularized myometrium, slow drug absorption into the CSP is predictable after the administration of systemic MTX .
At the early stage of our study first eight patients received a single doseAcarbose (1mg/kg) of intramuscular MTX in the ward before UAE. During the interventional operation we reduced MTX dosage to 50mg after prudently attempt to avoid nephrotoxicity and other toxic side-effect of excessive MTX. Among them, two patients had continuous growth of the embryos despite together with following MTX intramuscular administration and finally underwent hysterectomy.