Partial Trachelectomy: A New and Final Option for Fertility-Preserving Management of Cervical Ectopic Pregnancy

Abstract

Background: Although the application of methotrexate (MTX) and the development of interventional radiology has made uterine preservation possible for cervical ectopic pregnancy in most cases, hysterectomy is typically performed as the final measure to treat patients when conservative therapy has failed. By contrast, radical trachelectomy is often selected for early invasive cervical cancer to maintain the fertility of the patients. The aim of this study was to develop a fertility-sparing surgical procedure for cervical ectopic pregnancy. Case: A 26-year-old nulliparous woman suffered cervical ectopic pregnancy with a gestational age of about 8 weeks, and curettage caused uncontrollable hemorrhage after 6 courses of MTX treatment reduced the serum beta human chorionic gonadotropin level from 187,497 to 4 IU/mL. Then, the surgery “partial trachelectomy,” including (1) interruption of blood supply by ligating the bilateral descending branches of the uterine artery, (2) circumcision of the vaginal fornix and partial resection of cervical wall with the ectopic product of conception, and (3) reconstruction of the cervix and anastomosis between the vagina and cervix, was attempted to spare potential fertility, and the efficacy of this procedure was evaluated by observing the postoperative course. Results: Menstruation returned after 1 month and magnetic resonance imaging at 6 months postsurgery showed a normal corpus and small cervix. Conclusions: This potential fertility-preserving surgical technique should be applied when it is considered difficult to treat by using ordinary conservative therapy, including MTX administration, or when hysterectomy is indicated to save the life of a mother who still hopes to preserve her uterus. (J GYNECOL SURG 25:139)