Case Of Cervical Ectopic Pregnancy Research Articles

Bilateral Uterine Artery Embolization as a Rescue Method in a Rare Case of Cervical Ectopic Pregnancy

AbstractCervical pregnancy, being the second rarest form of ectopic pregnancy after abdominal pregnancy, is a difficult clinical entity to diagnose and manage in a young primigravida with no identifiable risk factors or associated symptoms. Further, early intervention is of utmost importance owing to the deleterious complications and high mortality associated with it if not addressed to. It is also difficult to choose a particular management approach for this out of the available options. We report a case of 23-year-old primigravida with 8 weeks of gestation, asymptomatic and with no underlying risk factors, diagnosed with cervical pregnancy during a routine antenatal scan. She was successfully managed with bilateral uterine artery embolization in conjunction with systemic methotrexate followed by suction and evacuation.

An undiagnosed case of cervical ectopic pregnancy: A case report

Cervical ectopic pregnancy very rarely presents in the second trimester. A 35-year-old female was diagnosed with a rare case of cervical pregnancy intraoperatively at 18 weeks as it was undetected prior. Emergency laparotomy was done as she started bleeding torrentially, and a hysterectomy was done as postpartum hemorrhage was noted. The patient recovered in 1 day and was discharged on day 10 without any postoperative surgical complications.

Bimodal approach for a case of cervical ectopic pregnancy

Ectopic pregnancy though rare can be a life threatening obstetric emergency without prompt diagnosis and treatment, can lead to significant mortality and morbidity. Incidence of Cervical ectopic pregnancy is <1%. The only viable option was hysterectomy in the past. However, at present various uterine conservative methods are available and can be life saving and drastically decreases the morbidity associated.28yrs G3P1L1A1 at 12 weeks 6 days of gestation with previous LSCS with previous history of Dilation & Evacuation came with USG report showing cervical ectopic pregnancy. Managed initially with 2doses of systemic methotrexate, in view of persistent complaints of spotting pervaginum patient underwent endocervical curettage.Early diagnosis and treatment of cervical ectopic pregnancy with combined approach can effectively reduce the chances of life threatening hemorrhage.

A rare case of cervical ectopic pregnancy

Cervical ectopic pregnancy is the implantation of conceptus in the cervical glands and fibrous cervical wall below the level of internal os. It is a rare and potentially life threatening condition associated with a high rate of maternal morbidity and accounts for less than 1% of all ectopic gestation. It may turn into an obstetric emergency, if not detected and treated early due to risk of severe hemorrhage. This entity can be diagnosed at early gestational age with help of ultrasonography and conservative approach of management help to preserve fertility. A 32- year female treated for secondary infertility via in-vitro fertilization(IVF) and embryo transfer(ET) with previous three dilation and curettage following previous missed conceptions presented with vaginal bleeding and Transvaginal ultrasonography revealed a cervical ectopic pregnancy of 5 weeks and 3 days with cardiac activity present. She was managed successfully by PGF2 alpha analogue administration preceding dilation and curettage of endocervical canal and cervical packing with hemocoagulase soaked gauze. Complete hemostasis was achieved and discharged after an uneventful hospital stay. Endocervical curettage is one of the minimally invasive management strategy in cervical ectopic pregnancy with cardiac activity and sufficient for full recovery with preservation of reproductive capacity. Our case demonstrates a new strategy combining systemic intramuscular prostaglandin and curettage for treatment of cervical ectopic pregnancy which may provide an efficient and safe alternative to embryocides at early gestational age.

Management of Cervical Ectopic Pregnancies: A Scoping Review.

To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics. PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy. A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy. Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.

Management of cervical ectopic pregnancy: A report of two cases

Cervical pregnancy is a rare and life-threating form of ectopic pregnancy. Early diagnosis and treatment can prevent undesired fatal consequences. We present two cases of cervical ectopic pregnancy managed with different medical modalities with literature review and highlights on different management modalities.

Successful Conservative Management of a Case of Cervical Ectopic Pregnancy complicated with Preexisting Cardiomyopathy

ABSTRACT Background Cervical ectopic pregnancies account for less than 1% of all pregnancies. It may present with abnormal and occasionally heavy bleeding. Aim To understand the challenges associated with management of cervical ectopic pregnancies and learn to individualize the available treatment modalities for a successful outcome. Case report A 42-year-old woman, G6P2L2MTP3 with amenorrhea of 2 months, was diagnosed with cervical ectopic pregnancy of 9 weeks on ultrasonography. She was a known case of dilated cardiomyopathy with type II diastolic dysfunction and an ejection fraction of 25%. The patient was given systemic methotrexate followed by intra-amniotic methotrexate and fetal intracardiac potassium chloride. She was followed up with serial β-human chorionic gonadotropin (hCG) reports. However, she developed abdominal pain with bleeding per vaginum and ultrasonography suggestive of a hematoma. The patient was then taken up for a bilateral uterine artery embolization followed by an immediate suction evacuation. The products of conception sent for histopathology confirmed the microscopic diagnosis of cervical pregnancy. Conclusion It is a challenging clinical situation to diagnose and manage. It needs to be diagnosed early, and management needs to be individualized. Clinical significance Even with advanced diagnostic modalities and reduction in current mortality rates, cervical pregnancy remains a life-threatening condition. It is of utmost importance to be thorough with the emerging trends in its management, as it comes with the promise of being unpredictably catastrophic. How to cite this article Raza N, PaiDhungat NP. Successful Conservative Management of a Case of Cervical Ectopic Pregnancy complicated with Preexisting Cardiomyopathy. J South Asian Feder Obst Gynae 2017;9(4):356-359.

A Case of Cervical Ectopic Pregnancy

Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervix1. Such pregnancy typically aborts within the first trimester, if it is implanted closer to the uterine cavity called cervico isthmic pregnancy it may continue longer2. Cervical pregnancy accounts for less than 1% of all ectopic pregnancies, with an estimated incidence of one in 2500 to one in 180003-5. Though the pregnancy in this area is uncommon but possibly life threatening condition due to risk of severe hemorrhage and may need hysterectomy. Early detection and conservative approach of treatment limit the morbidity and preserve fertility. A 26 years lady diagnosed as a case of cervical ectopic pregnancy and managed conservatively successfully with adjunctive techniques like cervical artery ligation and cervical temponade to control haemorrhage. The case is reported here for its relative rarity.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(1) : 31-35

Medical Management of Cervical Ectopic Pregnancy

Cervical ectopic pregnancy is a rare condition with implantation in the endocervical canal below the closed internal os. It accounts for less than 1% of all ectopic pregnancies. It is associated with high morbidity and mortality. A case of cervical ectopic pregnancy is reported. She was a young nulliparous female, timely referred from peripheral hospital. She was treated successfully with medical management and thus fertility was preserved

Conservative Management of Cervical Ectopic Pregnancy.

To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies. We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians. Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade. Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.

Cervical Ectopic Pregnancy: A Puzzling Event

Cervical ectopic pregnancy is the implantation of the conceptus within the cervix below the level of internal os1. Such pregnancy typically aborts within the first trimester, if it is implanted closer to the uterine cavity called cervico isthmic pregnancy it may continue longer2. Cervical pregnancy accounts for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 2500 to 1 in 18000. Though the pregnancy in this area is uncommon but possibly life threatening condition due to risk of severe hemorrhage and may need hysterectomy2,3. Early detection and conservative approach of treatment limit the morbidity and preserve fertility. A 37 year old lady para 4+0 diagnosed as a case of cervical ectopic pregnancy with intractable bleeding and save the patient by emergency hysterectomy to control hemorrhage. The case is reported here for its relative rarity.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i2.21072

Fever after Cervical Ectopic Pregnancy; a case report from Gorgan, Iran.

Ectopic pregnancy is a rare condition, and, although its prevalence has decreased in recent years, it is still an important cause of mortality and morbidity in women. Cervical ectopic pregnancy is less than 1% of all ectopic pregnancies. Fever is one of signs of infection, and it is necessary to monitor patients closely for other signs of infection. This paper presents and discusses a case of cervical ectopic pregnancy with fever after treatment. The patient had a high fever that became worse after three hospitalizations. The probable cause of her pyelonephritis was a urinary catheter, although it had been removed earlier, and she was receiving antibiotic therapy. Even though cervical ectopic pregnancy is a rare condition, it has certain complications that must be managed appropriately.

Cervical ectopic pregnancy: Mersilene tape in surgical management

In view of the rarity of cervical ectopic gestation and the potentially high morbidity that may be associated with its presentation and management, we report management of a case of cervical ectopic pregnancy using cervical cerclage with Mersilene tape as an intervention to reduce intraoperative haemorrhage during evacuation. The 36-year-old woman had a classic diagnosis of cervical ectopic pregnancy made in the consulting room with a transvaginal ultrasound examination. Evacuation with suction curettage was performed, and brisk bleeding was arrested with Mersilene tape. Placing a cervical cerclage is a relatively easy procedure to perform and may prevent major intraoperative bleeding, thereby minimising the risk of a major surgical procedure.

Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy.

Cervical pregnancy is a rare variety of ectopic pregnancy. The etiology is obscure. Its diagnosis may be difficult, and its management has enormously changed during the last 10 years. Unfortunately, the most effective, fertility-sparing treatment is still unclear until now. The aim of this study was to explore the safety and efficacy of different treatment modalities of cervical pregnancy. A comprehensive systematic review of the literature was performed using the electronic databases MEDLINE and PubMed, using key words cervical, ectopic, and pregnancy, between January 2005 and June 2013. We included all case reports and case series reporting on cervical ectopic pregnancy. A total of 252 cases of cervical ectopic pregnancy were analyzed. Eighty-eight cases (34.9%) had medical treatment, 69 cases (27.5%) had surgical treatment, and 95 cases (37.6%) had combined medical and surgical treatment. Various conservative treatment regimens have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used and effective drugs. A high index of suspicion, combined with meticulous review of clinical and radiological findings, is essential to make an accurate diagnosis of cervical pregnancy. The success of conservative treatment depends mainly on early diagnosis. Such cases would be best managed at specialist tertiary referral centers and preferably, where available, Early Pregnancy Assessment Units, whether medical, surgical, or combined treatment modalities were attempted.

Angiographic findings after vaginal gauze packing: New insight into an old technique

We had a transferred case of cervical ectopic pregnancy with hemorrhagic shock at 6 weeks of gestation. Upon arrival at hospital, we performed tight and full vaginal gauze packing to push the uterus upward to control the patient's hemorrhage. Following stabilization of her general condition, she was treated with uterine artery embolization. Using angiography, the effectiveness of vaginal gauze packing for emergency hemostasis by the presumed mechanism of impairing blood flow through the uterine artery was demonstrated. To our knowledge, there are no reports that have previously demonstrated angiographic findings similar to ours after vaginal gauze packing. Vaginal gauze packing is an effective, rapid, and convenient hemostatic procedure able to be carried out in a time-sensitive and challenging situation. As a result, this procedure gives clinicians more time to improve the patients' general status and arrange for transfusion and further definitive treatment.

Diagnosis and management of cervical ectopic pregnancy

Cervical ectopic pregnancy (CP) is a rare condition with an incidence of less than 0.1% of all ectopic pregnancies. It is associated with a high morbidity and mortality potential. Timely intervention is required to preserve fertility and avoid the need for a hysterectomy. A case of CP is reported and the challenges in the diagnosis and management are discussed.

A Case of Cervical Ectopic Pregnancy: Successful Therapy with Methotrexate

We report a case of cervical ectopic pregnancy (CEP) of six weeks' duration presenting with abdominal pain. The pregnancy was terminated by methotrexate without any known complications of CEP.

Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy

To describe cases of cervical or interstitial ectopic pregnancy managed conservatively with combined medical treatment (methotrexate and mifepristone) alone or in association with other minimally invasive strategies. We describe four cervical and two interstitial ectopic pregnancies at our hospital between 2006 and 2010. All received combined treatment with methotrexate and mifepristone. A search of MEDLINE is also described. The literature search identified only four previous cases of cervical ectopic pregnancies and no cases of interstitial ectopic pregnancy managed with combined therapy. In our study, all patients were successfully treated and had no adverse reactions with intramuscular methotrexate 50 mg/m² and oral mifepristone 600 mg, either alone or in association with minimally invasive treatment (uterine artery embolization and evacuation dilation and curettage). All patients remained asymptomatic with β-HCG levels that decreased and became negative within 14-49 days: the median hospital stay was 5.5 days. We also describe the first patient with a cervical ectopic pregnancy treated with methotrexate and mifepristone, followed by vaginal misoprostol 800 mcg for cervical evacuation. Methotrexate-mifepristone, either alone or in combination with other minimally invasive strategies, could be considered an option for the treatment of both cervical and interstitial ectopic pregnancy. An individualized approach should be used in each patient, however, given the wide variety of possible clinical situations and the potential seriousness of ectopic pregnancy.

Tratamiento médico de la gestación ectópica cervical: Nuevos avances

We report a case of cervical ectopic pregnancy with successful conservative treatment. The patient was treated with systemic methotrexate injections, which initially proved effective. However, severe genital bleeding subsequently developed, requiring cervical dilation and curettage for resolution. A radical change in the therapeutic approach was not required.

A rare case of cervical ectopic pregnancy treated successfully with single-dose methotrexate

Cervical pregnancy is the implantation of pregnancy in the endocervical canal; it is an infrequent form of ectopic gestation which accounts for 0.15% of all ectopic pregnancies. Diagnosis and treatment has changed dramatically in the last 20 years. Early detection by endovaginal ultrasound is desirable in order to plan management early and avoid serious and often life-threatening complications. A 24-year-old lady presented with 6 weeks of amenorrhoea with vaginal bleeding. She was diagnosed to have cervical ectopic pregnancy on ultrasound and was successfully treated with single-dose methotrexate.