Uterine artery embolization combined with methotrexate for broad ligament ectopic pregnancy in a 30-year old primigravida

Khurram Khaliq Bhinder, Shifa International Hospital, Islamabad, Pakistan
Azza Sarfraz, Aga Khan University
Zouina Sarfraz, Fatima Jinnah Medical University, Lahore, Pakistan
Shaista Riaz, McGill University, Montreal, Canada
Samreen Aslam, Shifa International Hospital, Islamabad, Pakistan
Zouina Ameena, Lahore General Hospital, Lahore, Pakistan


We present the case of 30-year old primigravida female at 11 weeks' gestation who was diagnosed to have ectopic pregnancy on obstetric ultrasound. An MRI pelvis was ordered to assess invasion into the posterior myometrium which confirmed a single right-sided broad ligament-extra uterine pelvic ectopic pregnancy with extrinsic mass effect on the right lower uterine segment without frank myometrial invasion. On an urgent basis, a uterine artery embolization (UAE) was performed by targeting the right femoral artery. Selective catheterization was performed of both uterine arteries and the right side showed a major feeder of the gestational sac. Supplied dose of methotrexate (95mg) was infused in the right uterine artery and both arteries were then embolized by gel foam slurry. Thus, prompt treatment reduced the risk of infertility and saved the patient from obstetrical emergency. Further exploration needs to be done in this field to explore conservative management options to preserve fertility.