OC05.02: Surgical treatment of first trimester cervical ectopic pregnancies

Abstract

Objectives: To assess the efficacy and safety of surgical evacuation in the management of cervical ectopic pregnancies. Methods: Women with a certain ultrasound diagnosis of cervical pregnancy were offered surgical evacuation under general anaesthetic. Procedures were performed under ultrasound guidance using suction curette. Shirodkar cervical suture was used selectively to secure haemostasis following evacuation of pregnancy. Intravenous ergometrine 500 μg was administered intra-operatively to ensure uterine contraction. The patients were prescribed prophylactic antibiotics and the suture was removed 48–72 hours later in the outpatient clinic. Results: Over a 10 year period 40 women were diagnosed with cervical pregnancy in our Units. Of the 40 cases, 39 (98%, 95% CI 87–100) women presented 12 weeks’ gestation with a viable fetus. 26/39 (67%, 95% CI 51–79) women underwent surgical evacuation, whilst the remaining 13/39 (33%, 95% CI 21–49) women were managed conservatively. The median intra-operative blood loss was 250mls (range, 50–2000). 10/26 (38%, 95% CI 22–57) women had Shirodkar cervical suture inserted to arrest intra-operative haemorrhage. 2/26 (8%, 95% CI 2–24) women required blood transfusion. The uterus was successfully preserved in all women. Two (8%, 95% CI 2–23) women required repeat surgical evacuation; one woman had retained products of conception and the other had persistent haematometra. There were no cases of pelvic infection or any other postoperative complications. Conclusions: Surgical evacuation is a safe and effective method in the management of first trimester cervical ectopic pregnancy. The use of Shirodkar suture minimises the need of blood transfusion and the risk of hysterectomy is very low.