Management of Cervical Ectopic Pregnancies: A Systematic Review [9Q

Abstract

INTRODUCTION: Cervical pregnancies are 0.01% of ectopic pregnancies and pose a considerable risk of hemorrhage. There is currently no consensus on management. This is a systematic review of published cases in the last decade. METHODS: PubMed and other databases were searched on July 2, 2017 using variations of the terms “cervical ectopic pregnancy” and “cervical pregnancy” for peer-reviewed citations published in English, Spanish, or French between 2007 and 2017. RESULTS: One-hundred-and-eleven articles representing 209 patients were included. Initial interventions included expectant management (3); vaginal removal of lesion (2); uterine artery embolization (UAE) (1); UAE and curettage (34); curettage (42); UAE and methotrexate (22); methotrexate alone (79); hysteroscopic resection (12), UAE and laparoscopy (5), and hysterectomy (6). Sixty patients failed initial intervention, including 38 who received methotrexate alone (58%), 5 who underwent methotrexate with UAE (26%), and 10 who underwent curettage (23%). Thirty-seven patients experienced hemorrhage, including 21% who initially received methotrexate; 40% who initially underwent curettage; and 12% of those initially managed with curettage and UAE. These patients were managed with hysterectomy (6); cerclage (4); curettage (7); UAE (7), and UAE and curettage (3). Overall patients did well with conservative management. CONCLUSION: For stable cervical ectopic patients, conservative management with methotrexate (including intraamniotic feticide if fetal cardiac activity is present) may be considered. Importantly, uterine artery embolization is worth considering prior to either surgical or medical management, and is recommended in any unstable patient.