Ectopic Cervical Pregnancy: Treatment Route.

Guglielmo Stabile,Giulia Zinicola,Federico Romano,Giuseppe Ricci,Francesco Paolo Mangino

doi:10.3390/medicina56060293

Guglielmo Stabile, Giulia Zinicola + Show 3 more

Open Access

https://doi.org/10.3390/medicina56060293

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Abstract

Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Results: In one patient treated by hysteroscopy alone it occurred a profuse vaginal bleeding with necessity for blood transfusion. Haemorrhage was controlled by a second hysteroscopic procedure. No complications, such as vaginal bleeding, were recorded in the other cases. Serum β-hCG levels become undetectable in a range of 15–40 days after hysteroscopic management; after medical treatment it become undetectable after 35 days. Serum βhCG levels had a faster drop the day after hysteroscopy than post medical management. The onset of a spontaneous pregnancy at the normal implantation site occurred after five months in one case treated by hysteroscopy. Conclusions: Many therapeutic approaches are effective for CP treatment. Hysteroscopy, alone or in combination with MTX, may provide a greater effect on the descent of βhCG, leading to a reduction of the hospitalization stay, decreasing costs and period for attempt pregnancy. Further prospective studies on larger samples are needed to define therapeutic protocols for CP management.

Highlights

Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal
On this basis we retain that conservative management of CP represents an emerging challenge
This work is based on a small sample of cases but it allows to compare the impact of different fertility-sparing strategies for CPs

Summary

Introduction

Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. The aetiology of CP is unknown, a history of dilation and curettage in a previous pregnancy has been identified as risk factors in nearly 70% of cases [1]. Other predisposing factors are previous caesarean delivery, cervical surgery, endometritis, use of an intrauterine device and in-vitro fertilization (IVF) [3]. Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Diagnosis is essential in order to allow conservative medical and surgical treatments. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included.

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