Cervical Pregnancy Research Articles

Future Perspectives of Ectopic Pregnancy Treatment-Review of Possible Pharmacological Methods.

Ectopic pregnancy, that is, a blastocyst occurring outside the endometrial cavity of the uterus, affects nearly 2% of pregnancies. The treatment of ectopic pregnancy is surgical or pharmacological. Since surgical management is associated with numerous serious side effects, conservative treatment is sought. The treatment of choice in the majority of cases is based on pharmacotherapy with methotrexate (MTX) in a single- or multi-dose regimen. Although the efficacy of methotrexate reaches between 70 and 90%, its use requires specific conditions regarding both the general condition of the patient and the characteristic features of the ectopic pregnancy. Moreover, MTX can cause severe adverse effects, including stomatitis, hepatotoxicity and myelosuppression. Therefore, clinicians and researchers are still looking for a less toxic, more effective treatment, which could prevent surgeries as a second-choice treatment. Some studies indicate that other substances might constitute a good alternative to methotrexate in the management of ectopic pregnancies. These substances include aromatase inhibitors, especially letrozole. Another promising substance in EP treatment is gefitinib, an inhibitor of EGFR tyrosine domain which, combined with MTX, seems to constitute a more effective alternative in the management of tubal ectopic pregnancies. Other substances for local administration include KCl and absolute ethanol. KCl injections used in combination with MTX may be used when foetal heart function is detected in cervical ectopic pregnancies, as well as in heterotopic pregnancy treatment. Absolute ethanol injections proved successful and safe in caesarean scar pregnancies management. Thus far, little is known about the use of those substances in the treatment of ectopic pregnancies, but already conducted studies seem to be promising.

Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery

We evaluated the impact of cervical cerclage combined with one or more uterine contraction inhibitors in persistent inhibition of uterine contraction for the treatment of late abortion and premature delivery. This retrospective case series study analysed the medical data of 58 patients who underwent cervical cerclage for cervical insufficiency and simultaneously received one or more uterine contraction inhibitors (indomethacin, ritodrine, and atosiban) and magnesium sulphate at the Zibo Maternal and Child Health Hospital between January 2019 and December 2020. Patients are normal pregnancy who received cervical cerclage without complications. The rate of successful treatment was 74.14% (43/58). The prolonged gestation duration was 16.42 ± 7.84 weeks, and the average delivery gestational age was 35.91 ± 5.16 weeks. The longest duration of treatment with a uterine contraction inhibitor or inhibitors in combination or with magnesium sulphate alone was 15.34 ± 13.16 days, and nine cases developed adverse reactions. Persistent uterine contraction inhibition after cervical cerclage could prolong pregnancy and improve pregnancy outcomes. Impact statement What is already known on this subject? A crucial reason for treatment failure of cervical cerclage is that uterine contraction was not effectively inhibited. What do the results of this study add? Persistent inhibition of uterine contraction after cervical cerclage prolonged pregnancy duration, increased gestational age at delivery, and improved pregnancy outcomes. What are the implications of these findings for clinical practice and/or further research? This study may provide a clinical basis for prolonging gestational age, preventing late abortion and premature delivery, and improving the survival rate and quality of life of premature infants.

Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with cervical pregnancy

Objective To evaluate the effectiveness of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in treating cervical pregnancy. Materials and methods This is a retrospective study. Seven patients with cervical pregnancy who visited the Third Xiangya Hospital of Central South University from January 2015 to December 2020 were enrolled in the current study. All seven patients were treated with HIFU under conscious sedation. All of them underwent HGSC at an average of 2 ± 1 days (range: 1–3 days) after HIFU. Before the therapy, the patient's clinical characteristics were collected, including duration of amenorrhea, gravidity and parity, the patient history of cesarean section and miscarriage, and the size of the gestational sac. The levels of β-hCG and hemoglobin in serum were also reviewed. To assess the clinical outcomes of this combined treatment, the suction time of HGSC, bleeding volume, the clearance time of β-hCG, and the time with returning of menstruation were evaluated. Results All seven patients (average age: 31 ± 6 years) have experienced amenorrhea (duration range, 48 ± 8 days) before the treatment of HIFU. The average number of pregnancies was four, and the number of deliveries was one. Previous medical history showed six patients had cesarean sections, and five patients have been miscarriages. After HIFU treatment, the fetal heartbeats were stopped in all seven patients based on the diagnosis by doppler ultrasound. The bleeding of gestational tissue decreased significantly. All patients had only mild lower abdominal pain, no fever, intestinal damage, or other complications were reported. The average operation time of operative suction curettage was 21 ± 9 min (range: 9–32 min), and the median bleeding volume was 10 ± 8 mL (range: 2–20 mL). Follow-up observations showed that the menstruations were returned in patients at an average of 38 ± 9 days (range: 30–50 days) after the treatment. The β-hCG decreased from 41773 ± 32242 mIU/mL to 13101 ± 8454 mIU/mL in 29 ± 10 days after surgery. Conclusion Based on these results with small subjects, we concluded that HIFU combined with HGSC might be an effective and safe treatment for patients with cervical pregnancy.

Comparison of high-intensity focused ultrasound ablation and uterine artery embolization in the management of cervical pregnancy.

BackgroundCervical pregnancy (CP) is an uncommon type of ectopic pregnancy with a rising risk to life. Currently, there is no universal protocol for the safe and effective management of CP. This study aimed to investigate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) vs. uterine artery embolization (UAE) in the management of CP to develop a standard for the treatment of CP.MethodsFrom January 2015 to October 2021, 36 patients with CP were diagnosed, treated, and followed up at the Department of Gynecology of Third Xiangya Hospital of Central South University. A total of 11 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, and 25 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Medical records and pregnancy outcomes were retrospectively analyzed.ResultsCompared to the UAE group, the HIFU group had a shorter interval time (1.5 ± 0.21 days vs. 2.6 ± 0.26 days), shorter duration of hospitalization (5.5 ± 0.31 days vs. 6.6 ± 0.21 days), shorter recovery time of menstruation (30.6 ± 7.09 days vs. 36.9 ± 5.54 days), fewer adverse reactions (0/11 vs. 9/25), and fewer postoperative complications (1/11 vs. 8/25). There were no significant differences in age, gravidity, parity, abortion, gestational age, cardiac pulsation, admission symptoms, hemoglobin level, largest diameter of the sac/mass, serum human chorionic gonadotropin (hCG) level at admission, hospitalization expenses, hospitalization days, blood loss during curettage, degree of hCG decline, residue after curettage, fertility requirement, and pregnancy outcomes.ConclusionBoth HIFU and UAE are safe and effective in the treatment of patients with CP. Compared to UAE, HIFU treatment for CP is a safer and more effective therapeutic schedule owing to the advantages of being more minimally invasive, shorter interval time, shorter hospitalization days and recovery time of menstruation, fewer adverse reactions, and fewer postoperative complications.

EP40.28: Experience in the diagnosis, treatment and outcome of cervical and interstitial ectopic pregnancies

To describe the relevant findings in the diagnosis of cervical ectopic pregnancy CEP and interstitial ectopic pregnancy IEP in order to focus their management. This observational study included patients diagnosed with ectopic pregnancy between January 2019 and February 2022 at the Fundacion Santa Fe de Bogotá University Hospital. Paraclinical and ultrasonographic variables were evaluated. A descriptive analysis of the patients. To be selected, cases of PSC and IEP had to meet the ultrasonographic criteria of the Society of Obstetricians and Gynecologists of Canada, SCOGC, and cases of IEP had to meet the Timor-Tritsch criteria. The management established for each case and the prognostic factors for the success of pharmacological and/or surgical treatment were then discussed. Of 502 medical attendances for bleeding and pain in the first trimester of pregnancy, 102 were diagnosed as ectopic pregnancies, of which 3 cases of CEP and 2 cases of IEP were selected. Of the 2 IEP cases: BhCG level of 4670 and 2016 mIU/mL, both had a vascularised gestational sac (GS) without embryo, gestational age less than 6 weeks and were treated with multiple doses of Methotrexate (MTX) 1mg/kg, neither required surgical treatment. Of the 3 cases CEP BhCG level of 37174, 4770, 865 mIU/mL, all 3 had a vascularised gestational sac (GS), gestational age less than 9 weeks, no embryo and were treated with multiple doses of Methotrexate (MTX) 1mg/kg, two required surgical treatment and one was additionally treated with intrasaccular methotrexate. Multi-dose and intrasaccular MTX management of CEP and IEP reduced the need for QM. Determining factors for treatment success were BHGC levels at diagnosis, presence or absence of embryo, and gestational age.

Rare abnormal pregnancy implantation: A case report of 39 year old G2P1 with cervical ectopic gestation

The case is that of a 39 year old G2P 1, 1 alive who presented with recurrent bleeding per vagina following 8weeks amenorrhea, Pregnancy confirmed with urine test. She was married and no attempts at termination of pregnancy. Ultrasound scan revealed empty uterus without any adnexea mass but a gestational sac in the cervical canal with an active fetus and vascular flow on Doppler colour interrogation. A diagnosis of cervical ectopic pregnancy was made and she had medical management with initial mifepristone and then intramuscular methotrexate. A subsequent gentle evacuation of the cervical canal was done and trans-cervical catheter inserted for 2 weeks to prevent cervical adhesion. Urine Pregnancy test done after 3 weeks was negative. Conclusion: Cervical ectopic pregnancy is one of the very rare forms of pregnancy implantation that can be associated with devastating outcome but prompt diagnosis and management help improve patient’s prognosis.

Knowledge and Attitude of Cervical Cancer Screening and Vaccination in Patients Attending Gynecology Outpatient Clinic at a Tertiary Care Hospital in Pakistan.

Shamaila ShamaunBackground Cervical cancer is the third most prevalent female cancer in Pakistan; nearly 70% present at a very advanced stage of malignancy due to lack of awareness, proper screening, and vaccination. Therefore, we aimed to assess the knowledge and attitude toward screening, vaccination, and risk factors of cervical cancer in sexually active women of Pakistan. Methods This cross-sectional study was conducted at the gynecology outpatient clinic of a public sector hospital in Karachi, Pakistan, from December 2021 to March 2022. We included sexually active women with exception of diagnosed cases of cervical cancer, pregnancy, vaginal bleeding, and psychological disorder. Collected data were regarding demographic characteristics, awareness regarding cervical cancer, screening, human papillomavirus (HPV) vaccine, and risk factors, history of cervical screening, and wiliness to opt-in for cervical screening. Results We included 226 women with a mean age of 41.25 ± 10.54 years. The mean parity level was observed to be 3.8 ± 1.95. A majority of women were housewives by profession (88.9%) and uneducated (61.9%). Only 41.2% (93) of women were aware of cervical cancer, 33.6% (76) were aware of cervical screening, and only 15.9% (36) had a history of cervical screening. Only four women (1.8%) were aware of the HPV vaccine and 31% (70) showed intention to opt-in for cervical screening. A vast majority of women (96.9%) were not aware of the risk factors of cervical cancer. Conclusion(s) We have observed poor awareness regarding cervical cancer, HPV vaccination, and cervical screening among women in our population. Lack of awareness was not restricted to a certain segment but it prevails all across the demographic in our population.

The trend of the distribution of ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy

BackgroundEctopic pregnancy is a life-threatening occurrence and is an important cause of pregnancy-related mortality. We launched the study to investigate the distribution and its variation trend of the ectopic pregnancy sites and the clinical characteristics of caesarean scar pregnancy, to provide information for further clinical practice.MethodsA total of 3915 patients were included in our study to calculate the distribution of the implantation sites of ectopic pregnancies. Then, we performed a χ2 test for trend and calculated the quantity of each type of ectopic pregnancy during 2012–2015 and 2016–2019 to analyse the variation trend.Results(1) The proportion of each site of ectopic pregnancy was as follows: tubal pregnancy (84.70%), ovarian pregnancy (1.56%), caesarean scar pregnancy (8.63%), abdominal pregnancy (0.61%), cornual pregnancy (2.68%), cervical pregnancy (0.49%), heterotopic pregnancy (0.43%). (2) Through the χ2 test for trend, the ratio of caesarean scar pregnancy to ectopic pregnancy showed an upward trend (P = 0.005). From 2012 to 2015 and 2016–2019, the ratio of caesarean scar pregnancy to ectopic pregnancy increased from 5.74 to 11.81% (P < 0.001). (3) A total of 72.78% (246/338) caesarean scar pregnancy patients had one caesarean delivery, 25.15% (85/338) had two caesarean deliveries, and 2.07% (7/338) had three caesarean deliveries. A total of 80.18% (271/338) had aborted before. The most common clinical manifestations were amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign was uterine enlargement (46.75%).ConclusionAs the ratio of caesarean scar pregnancy increases, the caesarean delivery rate should be decreased to decrease the morbidity of caesarean scar pregnancy.

Ectopic Pregnancy: A 10 -Year Review of Cases in A Tertiary Health Institution in Umuahia, South East, Nigeria

Background: Ectopic pregnancy is a clinical condition where a fertilized ovum implants outside the endometrium of the uterine cavity. Worldwide, ectopic pregnancy complicates 0.25-2.0% of all pregnancies. High index of suspicion of the clinical triad; abdominal pain, amenorrhea and vaginal bleeding is very important for its early detection and management. Objectives: To determine the prevalence, clinical presentations, sites, risk factors and outcomes of ectopic pregnancy in a tertiary health institution in Umuahia, Nigeria. Materials and Methods: This retrospective study was conducted in the Department of Obstetrics and Gynaecology, Federal Medical Centre, Umuahia over a period of 10years from January 2011 to December 2020. The records of patients with ectopic pregnancy were traced through the main theater, ante-natal clinic, and the records unit. All information obtained were coded, entered into and analyzed using IBM SPSS version 25. Results: A total of 268 patients with ectopic pregnancies were studied out of 19,535 gynecological cases and 13,901 deliveries within the study period. This gave a prevalence of 1.4% of all gynecological cases and 1.9% of all deliveries. Ectopic pregnancies occurred more in women between 26 and 35years of age (54.9%). The commonest symptoms seen were abdominal pain (24.7%), Amenorrhea (22.7%) and vaginal bleeding (22.1%). The commonest sites of occurrence were fallopian tube 244 (91.1%), intramural (3.4%) and cervical ectopic pregnancy (2.2%). All the patients were managed surgically while 84% had ruptured uterus. Risk factors observed were a history of PID (30.0%), previous ectopic pregnancy (14.6%), infertility (12.5%), IUCD placement (12.1%) and previous abortion (11.2%). Conclusion: Ectopic pregnancy is one of the leading causes of maternal morbidity and mortality for women of reproductive age. Early diagnosis and management in form of medical treatment or conservative surgery not only reduces maternal morbidity and mortality but also preserves future fertility.

ЭФФЕКТИВНОСТЬ ОРГАНОСОХРАНЯЮЩЕЙ ТАКТИКИ ВЕДЕНИЯ ПРИ ШЕЕЧНОЙ БЕРЕМЕННОСТИ

Abstract. Diagnosis of cervical pregnancy is carried out based on the analysis of data obtained during the study of the gynecological status during bimanual abdominal - vaginal and ultrasound examinations. Treatment consists in performing organ-preserving manipulations and, in the absence of their effectiveness, extirpation of the uterus. Prevention of the development of cervical pregnancy consists in the rational treatment of gynecological diseases, refusal of abortions, carrying out full-fledged rehabilitation after intrauterine interventions. In this clinical case, prevention of unwanted pregnancy by prescribing rational contraception, timely diagnosis of the causes of infertility and miscarriage, as well as prevention and effective treatment of chronic endometritis would avoid the risk of cervical pregnancy. Careful management of pregnancy by an obstetrician-gynecologist made it possible to identify the ectopic location of the fetal egg in the early stages of pregnancy and prevent the occurrence of severe life-threatening complications, as well as perform organ-preserving surgical treatment, giving the patient the opportunity to realize the childbearing function in the future. Based on the study of this clinical case, it can be concluded about the effectiveness of the proposed management tactics of a patient with cervical pregnancy and the possibility of recommending this variant of medical tactics in the treatment of patients with this pathology.

Effect of Castor Oil on Cervical Ripening and Labor Induction: a systematic review and meta-analysis.

ObjectivesPost-term pregnancy is a condition associated with increased maternal and fetal complications. Administration of castor oil causes cervical stimulation by increasing the production of prostaglandins. We examined the effects of castor oil on cervical ripening and labor induction through a systematic review and meta-analysis.MethodsThe search process was performed to obtain relevant articles from databases including Pubmed, Cochrane library, Scopus, Science direct, SID, Iran Medex, and Google Scholar using the English keywords of cervical ripening, post-term, castor oil, labor induction, Bishop score, and pregnancy considering all possible combinations without time constraints and their Persian equivalents from national databases.ResultsA total of eight related articles from the 19 primary studies were extracted and systematically reviewed. According to a cumulative chart, the difference in the post-intervention Bishop score was statistically significant (standard mean difference [SMD] 1.64, 95% confidence interval [CI] 1.67-2.11, p = 0.001), indicating an effect of castor oil on increasing the Bishop score. In addition, the difference in labor induction was statistically significant after the intervention (odds ratio 11.67, 95% CI 3.34-40.81, p = 0.001), indicating an effect of castor oil on increasing the odds ratio of labor induction (experience of vaginal delivery).ConclusionThis meta-analysis showed that oral administration of castor oil is effective for cervical ripening and labor induction. Midwives should closely monitor pregnant women with prolonged labor and collaborate with obstetricians to employ castor oil as a safe intervention to induce cervical ripening and labor to prevent undue caesarean surgery.

Effectiveness and safety of ultrasound-guided intramuscular lauromacrogol injection combined with hysteroscopy in cervical pregnancy treatment: A case report

BACKGROUNDCervical pregnancy is increasing in morbidity, and a definite diagnosis in early stages is challenging due to its specific onset site. Surgery is the mainstay of treatment for cervical pregnancy, but it may result in the loss of natural fertility. Therefore, it is a great challenge to pursue a safe and effective treatment for cervical pregnancy.CASE SUMMARYWe report the case of a cervical pregnancy successfully treated by ultrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy. A 23-year-old woman with minor irregular vaginal bleeding was admitted to our department with suspected ectopic pregnancy. Transvaginal ultrasound revealed a gestational sac (approximately 22 mm x 13 mm) situated in the cervical canal with a yolk sac and blood flow signals. No cardiac activity was detected. Serum beta progesterone was 17.06 ng/mL, and serum beta human chorionic gonadotropin (β-HCG) was 5077.0 IU/L. The patient was diagnosed with cervical pregnancy. She was treated by ultrasound-guided cervical-intramuscular injections of lauromacrogol (3 mL) in combination with aborting under hysteroscopic visualization. A gradual decrease in β-HCG levels and normal ultrasound findings were observed. Postoperative pathologic examination showed the presence of villi and changes in the endometrium in the secretory phase. The patient was discharged on day 6, and her β-HCG level was 0.67 mIU/mL after 1 wk. There was no statistical difference between baseline and 1-week postoperative data in terms of serum indices including liver function, renal function, and routine blood analysis after treatment. The patient subsequently became pregnant 2 mo later and no abnormalities were detected on routine screening during pregnancy. CONCLUSIONUltrasound-guided cervical-intramuscular lauromacrogol injection combined with hysteroscopy may be effective and safe in the treatment of cervical pregnancy.

A Case Report of Cervical Ectopic Pregnancy in Early Gestation

Cervical ectopic is a life-threatening gynaecological emergency. It is highly prone to severe hemorrhage with maternal morbidity and mortality. It has an incidence of 1% and requires prompt diagnosis. Management is usually individualized and depends on gestational age, presentation severity and the available options and expertise. It could be medical, surgical endoscopically or a combination of treatment. A cervical ectopic in a 32-year-old nullipara who had a negative exploratory laparotomy on account of missed cervical ectopic and later a failed medical management with methotrexate. She subsequently had a dilatation and curettage under spinal anesthesia followed by medical management with repeat three doses of systemic methotrexate due to persistent haemorrhage. She was monitored with a serial level of beta human chorionic gonadotrophins until normal level was attained. Cervical ectopic is a rare form of ectopic gynaecological health workers need to have a high index of suspicion in making diagnosis and prompt intervention instituted. Though there is no standard management protocol, combination therapy of available management options has proven to be effective.

Early cervical cancer treatment and pregnancy

Cervical cancer is the 4 the most common cancer in women’s across the world, with a 10 year survival rate of more than 60%. An important proportion of these women are at a reproductive age. Therefore depending of the stage at the time of diagnosis, different approaches have been used in order to preserve fertility function. Two methods have been tried, knife biopsy with or without laparoscopic lymphadenectomy and trachelectomy for IA1, respectively IA2-IB1. Described by Dargent in 1994, has changed approach in cervical cancer for young women that have not completed their families. The rational behind this technique is to remove the cervix and surround parametrium, followed uniting the vagina to the isthmus, anastomosis which is reinforced by a stich.

Ectopic pregnancy of cervical localization: modern aspects of treatment

Annotation. A review of the scientific literature on the problem of diagnosis and modern methods of treatment of cervical pregnancy is presented. Ectopic pregnancy (ectopic pregnancy) is a condition in which the implantation and development of a fertilized egg takes place outside the uterine cavity and is one of the threatening conditions for life and reproductive health of women. Cases of cervical pregnancy occur with a frequency between 1:8 600 and 1:12 400 cases of the total number of all pregnancies and less than 1% of the number of ectopic pregnancies. Suspicion of a diagnosis of “cervical pregnancy” is an indication for immediate hospitalization of the woman in a gynecological hospital, a thorough examination and selection of treatment, because this pathology can provoke massive bleeding in the first trimester of pregnancy. In the practice of obstetrician-gynecologist for a long time there was one method of treatment of this pathology – extirpation of the uterus. To date, there are conservative and surgical treatments, that we will cover in this article. We conducted a systematic review and analysis of relevant literature sources, which have been published in the vast majority over the past 10 years (2012-2022), on modern methods of diagnosis and treatment of cervical pregnancy. The search was conducted in search databases PubMed, Google Scholar, Cochrane Library, Web of Science. The following search terms were used in the work: “cervical pregnancy”, “ectopic pregnancy”. It was found that the problem of treatment of cervical pregnancy remains relevant today, because there is no clear opinion on the best method of treatment. The decision to use one or another method is left to the attending physician, who must adequately assess the patient's condition, obstetric situation and possible options for prescribing appropriate treatment, the available methods were justified.

Association among Spinnbarkeit , Electrical Conductivity , and Crystallization of Cervical Mucus and Pregnancy Rate in Egyptian Baladi Cows

Association among Spinnbarkeit , Electrical Conductivity , and Crystallization of Cervical Mucus and Pregnancy Rate in Egyptian Baladi Cows

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.

Cervical pregnancy management by lauromacrogol combined with intrauterine visualization system and vacuum aspiration: two case studies

Background: Timely and effective intervention can avoid the need for hysterectomy in cervical pregnancy. This study reported 2 cervical pregnancy cases treated with lauromacrogol combined with intrauterine visualization system and vacuum aspiration under direct vision and negative pressure suction. Cases: A 33-year-old (para 0-0-2-0) and 26-year-old females (para 1-0-1-1) were admitted to our hospital for amenorrhoea followed by vaginal bleeding, with previous history of laparoscopic salpingectomy for ectopic pregnancy, and cesarean section and hysteroscopic resection of retained placenta after induced abortion, respectively. Both patients were treated with lauromacrogol combined with intrauterine visualization system and vacuum aspiration along with Foley catheter compression. Both surgeries were completed in one go. The effect was significant, safe, feasible, with no massive vaginal bleeding or complications. The serum hCG decreased rapidly, and the length of hospital stay was short. Conclusions: This combined treatment method has a definitive effect, and the application can be promoted clinically.

AN OBSTETRICIAN’S DAYMARE : CERVICAL PREGNANCY WITH PLACENTA PERCRETA : A CASE REPORT

Objective: Cervical pregnancy along with Placenta Accreta Spectrum (PAS) disorders is an extremely rare and deadly entity which is not only challenging in diagnosis but in management also. Here, a case of cervical pregnancy complicated with placenta percreta and bladder invasion at 14 weeks of gestation is presented . Case Report: A 35-year-old woman, Gravida 3, para 2, living 1 with previous 1 cesarean was diagnosed with cervical pregnancy at an estimated +4 gestational age of 13 weeks. Patient presented with vaginal bleeding which couldn't be managed conservatively , and Peripartum hysterectomy was performed eventually. Decision for Surgery was taken in view of acute episode of massive vaginal bleeding not controlled by curettage . Intraoperatively cervical ectopic pregnancy with placenta percreta involving the bladder was found. Peripartum Hysterectomy along with DJ stenting and bladder repair was performed. Post operative period had been uneventful. Conclusion:Cervical ectopic pregnancy with placenta percreta with bladder invasion can result in maternal mortality and morbidity. Timely decision making can help with successful treatment and management of bleeding. We thus present our experience of the management of this rare condition

Intrauterine Bigatti Shaver (IBS ® ) successful placental remnants removal, after caesarean section for a cervical pregnancy with placenta accreta.

Placenta accreta located in a caesarean section scar is difficult to remove. The Intrauterine Bigatti Shaver (IBS®) has already been proven to be effective in placental remnant removal. Our case report highlights that the IBS® is also a safe method to remove placental remnants attached to a previous caesarean section scar performed for a cervical pregnancy and associated with placenta accreta.