Cervical Pregnancy Research Articles

Selective uterine artery embolization is a valid adjuvant treatment of choriocarcinoma: a case report and literature review

BackgroundCervical choriocarcinoma is an extremely rare malignancy that is often misdiagnosed due to its nonspecific symptoms, such as vaginal bleeding.Case reportA 39-year-old female presented to the emergency department of the First Affiliated Hospital of Sun Yat-sen University with vaginal bleeding and a serum β-human chorionic gonadotropin (β-HCG) level of 229,386 mIU/mL. Initially, she was misdiagnosed with cervical pregnancy and subsequently underwent selective uterine artery embolization and cervical mass excision. However, pathological examination revealed the diagnosis of cervical choriocarcinoma.ConclusionThis case highlights the propensity for misdiagnosis of cervical choriocarcinoma. Selective uterine artery embolization proves to be an efficient measure to manage hemorrhage and potentially avoid unnecessary hysterectomy.

Management of nontubal ectopic pregnancies - single center experience

Aims: Ectopic pregnancies can be defined as pregnancies in which the growing blastocyst implants outside the endometrial cavity. However, it is assumed that 0.5-1% of all pregnancies are ectopic pregnancies. The most common extrauterine implantation site is the fallopian tube. Non-tubal pregnancies (NTG Non-tubal pregnancies) account for less than 5% of all ectopic pregnancies but cause 8 times higher maternal mortality than tubal pregnancies. The study aimed to determine the frequency of nontubal ectopic pregnancies in a tertiary care unit in Turkey and the differences that may differentiate patients from tubal ectopic pregnancies. Methods: The purpose of this retrospective study was to analyze and describe the treatments of patients who were hospitalized for ectopic pregnancy in the Gynecology and Obstetrics Clinic of Mengücekgazi Training and Research Hospital from May 2014 to May 2024. Obstetric/gynecologic history, risk factors for previous ectopic non-tubal pregnancy, serum-hCG levels at the moment of diagnosis, ultrasound findings, surgical or medical treatment and treatment outcomes were presented. Results: In our institutional records, 240 patients received an ectopic pregnancy diagnosis. and n=23 nontubal ectopic pregnancies were identified. Cervical pregnancy (CP) (n=2), interstitial pregnancy (IP) (n=2), cesarean scar pregnancy (ScP) (n=10), ovarian pregnancy (OvP) (n=9) were detected. Conclusion: It emerges from our sample that NT-EP needs to be diagnosed quickly. This can assist in the conservative use of a medical or minimally invasive method. The significant advance in imaging technologies allows for a faster diagnosis, allowing the patient to be transferred to a referred center from where the best procedures can be selected, reducing the potential impact of surgery on the patient’s fertility.

Early diagnosis, effective treatment: modern approaches to the management of ectopic pregnancies

Purpose of research: The aim of this article is to provide an overview of the diagnosis and management of atypical ectopic pregnancy, with particular reference to pregnancy in the cesarean scar. The importance of early detection and medical intervention will be described, as well as the impact of advanced diagnostic techniques and modern treatments on the curability of patients.This article aims to provide valuable insights into the development of effective strategies for the diagnosis, treatment and prognosis of ectopic pregnancy. State of knowledge: Ectopic pregnancies account for 1-2% of all pregnancies, with the majority (90%) occurring in the fallopian tube. Less commonly, they present as ovarian, cervical or abdominal pregnancies. Advances in diagnosis and treatment have made it possible to identify rare forms such as cesarean scar pregnancy (0.15% of all pregnancies), interstitial pregnancy and recurrent ectopic pregnancy on tubal remnants. Techniques such as transvaginal ultrasound (TVS), MRI and laparoscopy have the potential to improve diagnostic accuracy and treatment outcomes. Modern interventions such as transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and methotrexate have shown promise in terms of safety and efficacy. Conclusions: Ectopic pregnancy and its complications have a significant impact on the psycho-physical health of patients, requiring ongoing research to improve diagnostic and therapeutic methods. Future studies should focus on long-term outcomes and the coordination of multidisciplinary medical care to further improve diagnosis and treatment.

Clinical characteristics analysis of heterotopic cervical pregnancy

Objective: To investigate the clinical characteristics of heterotopic cervical pregnancy (HCP). Methods: A retrospective analysis was conducted based on the general clinical data, assisted reproductive technology (ART) data, diagnosis and treatment data, and pregnancy outcomes of 17 patients diagnosed with HCP who received ART at the Reproductive Medicine Center of Peking University Third Hospital from January 2011 to April 2022. Results: The age of 17 HCP patients was (34.2±1.5) years, all of whom occurred after the application of ART; Among them, 11 cases had a history of uterine cavity operation. All 17 patients had vaginal bleeding, with only 1 case accompanied by abdominal pain. The gestational age at the diagnosis of HCP was [6+2 (5+2-6+4)] weeks. Two patients underwent conservative observation and were closely followed up. Both of them had intrauterine pregnancy until full-term and underwent cesarean section; One patient underwent ultrasound-guided cervical pregnancy reduction surgery, resulting in miscarriage due to premature rupture of membranes at 18+1 weeks of intrauterine pregnancy; One patient underwent ultrasound-guided cervical pregnancy reduction surgery, followed by uterine artery embolization, hysteroscopy, removal of cervical pregnancy lesions, and curettage due to excessive bleeding; One patient underwent uterine artery embolization, hysteroscopy, cervical pregnancy lesion clearance, and curettage due to excessive vaginal bleeding; One patient underwent hysteroscopy examination, cervical pregnancy lesion removal surgery, and uterine curettage due to embryo arrest during intrauterine pregnancy; 11 cases underwent ultrasound-guided cervical pregnancy lesion clearance surgery, all of which resulted in live births. Among the 13 delivery patients, 4 cases were premature and 9 cases were full-term; 5 cases of vaginal delivery and 8 cases of cesarean section. Conclusions: The most common clinical manifestation of HCP is vaginal bleeding. Ultrasound guided cervical pregnancy lesion clearance surgery is safe and feasible, and with good pregnancy outcomes.

Emergency and prophylactic uterine artery embolization in gynecology and obstetrics - a retrospective analysis.

This study aimed to evaluate the safety and efficacy of emergency and prophylactic uterine artery embolization (UAE) in our clinical practice, including technical success, clinical success, and associated complications. In this retrospective study, we analyzed 64 women who underwent emergency (n =18) and prophylactic (n = 46) UAE. Indications for emergency UAE included postpartum hemorrhage or severe hemorrhage during pregnancy termination, while prophylactic UAE was performed prior to surgical removal of retained products of conception (RPOC), delivery with abnormal placental implantation, or pregnancy termination (cervical pregnancy or fetal anomalies accompanied by abnormal placental implantation). Technical success of UAE was defined as complete exclusion of the vascular lesion and contrast stasis on the final angiogram, while clinical success was defined as cessation of bleeding after UAE Termination without a hysterectomy. The overall clinical success of UAE in our study was 97% (62/64). All embolization procedures were technically and clinically successful in the prophylactic group without life-threatening hemorrhages or hysterectomies (100% success rate, 46/46). However, while 100% technical success was similarly attained in the emergency group, bleeding was successfully controlled in 89% of cases (16/18). In two patients with significant blood loss (over 2000 mL), embolization failed to achieve hemostasis, resulting in persistent bleeding and subsequent hysterectomy. UAE is a safe and effective procedure for managing primary postpartum hemorrhage or severe hemorrhage during pregnancy termination and for decreasing the risk of severe hemorrhage during surgical removal of RPOC, delivery with abnormal placental implantation, or pregnancy.

Evaluation of estrus detection by cervical monitoring and pregnancy rates in ovsynch and co-synch treated Anatolian buffalo heifers

The aim of this study was to assess the relationship between the occurrence and intensity of estrous expression and the success of artificial insemination in Ovsynch and Co-synch treated Anatolian buffalo heifers, employing a novel approach utilizing smartphone-based endoscopic inspection of the cervix uteri. Twenty-seven Anatolian buffalo heifers (n=27) were utilized for the study. In the Ovsynch synchronization protocol (n=15), GnRH (buserelin acetate, 12 μg) was administered on day 0, PGF2α (cloprostenol, 500 μg) on day 7, and GnRH (buserelin acetate, 12 μg) on day 9, with artificial insemination conducted 16-20 hours after the second GnRH application. For the Co-synch protocol (n=12), GnRH (buserelin acetate, 12 μg) was administered on day 0, PGF2α (cloprostenol, 500 μg) on day 7, and GnRH (buserelin acetate, 12 μg) along with artificial insemination on day 10. At the time of artificial insemination, estrous expression was categorized as intense, moderate, weak, or negative. Pregnancies were confirmed between 40 to 70 days after artificial insemination using either pregnancy-related glycoprotein or ultrasonography examinations.Intense, moderate, weak, and negative estrus intensities were observed at rates of 20%, 20%, 26.7%, and 33.3%, respectively, in the Ovsynch group and 41.7%, 58.3%, 0%, and 0%, respectively, in the Co-synch group (P

O-028 DNA methylation testing with cervical secretion can serve as a non-invasive biomarker for predicting successful implantation in frozen-thawed embryo transfer

Abstract Study question Is cervical secretion gene methylation profile associated with embryo implantation outcome, and can be used as a non-invasive biomarker for pregnancy prediction in FET cycles? Summary answer Cervical secretion gene methylation profiles show significant associations with implantation outcomes, and can serve as a non-invasive predictor of successful pregnancy in FET cycles. What is known already Cause of implantation failure remains a black box in reproductive medicine, and the exact mechanism of how endometrial receptivity is still behind the curtain. Epigenetic modifications including DNA methylation regulate gene expression and may alter endometrium receptivity. Endometrial DNA methylation changes vigorously only during the reconstruction of a new endometrium throughout each menstrual cycle, suggesting a unique methylation landscape in each regenerated endometrium. Cervical secretions contain implantation-related cytokines and genetic material from endometrium, and the DNA methylation profiles of cervical secretions is highly correlated with endometrium. Therefore, cervical secretions can be used as non-invasive surrogates for investigating endometrial condition. Study design, size, duration This multi-centered, case-control study enrolled 72 infertile females who entered the FET cycle with at least one high-quality blastocyst available between Aug 2017 and Dec 2022. Embryos assessed by Gardner scoring system with grade 3BB or above were defined as high-quality. Cervical secretions were collected on the day right before embryo transfer, and then DNA methylation profile were assessed. Participants/materials, setting, methods These females aged between 20-45 years-old with regular menstruation cycle (24-35 days) and normal BMI (17.5–32.0 kg/m2). Uterine cavity lesions and hydrosalpinx without treatment, adenomyosis, large uterine myoma that distorted endometrium, and thin endometrium (<7mm) were excluded. The association between the cervical secretion gene methylation profile and pregnancy outcome was evaluated via quantitative methylation-specific PCR (qMSP), methylation array, and genome-wide analysis. Different machine learning algorithms were utilized for differential methylation analysis and implantation prediction. Main results and the role of chance Cervical secretion DNA methylome differed between receptive (pregnant) and non-receptive (non-pregnant) FET cycle with genome-wide methylation array. The accuracy of pregnancy outcome prediction using top 2000 differential methylation probes (DMPs) in promoter region can be as high as 86% in all tested sample and 96.4% in pregnant samples. Bioinformatic analysis of six selected candidate genes related to implantation from literature review showed significant differences in DNA methylation between receptive and non-receptive endometrium. The methylation level of the six candidate genes with eight regions were measured by the qMSP platform and showed varying degrees of differential methylation status between the pregnancy and non-pregnancy groups. The AUCs for a single gene/region ranged from 0.53–0.67 for implantation prediction. Ten different machine learning models were applied and the results showed that the combination of candidate genes’ DNA methylation profiles could differentiate pregnant from non-pregnant samples with an accuracy as high as 86.67% and an AUC of 0.81 by logistic regression model. The best model from different machine learning algorithms using selected DMPs of genes related to window of implantation (WOI) can predict ongoing pregnancy with accuracy rates as high as 86.78% and AUC values up to 0.91. Limitations, reasons for caution The results obtained from a relatively small cohort size, and the timing of sample collection is on the day right before embryo transfer. Further investigation of methylation profiles in late follicular phase along with large sample size with euploid embryo transfer are mandatory for validation and clinical applications. Wider implications of the findings We firstly demonstrated the feasibility of cervical secretion methylation profile as a non-invasive testing for pregnancy prediction. The promising result may contribute to predicting endometrial receptivity for cycles with a favorable endometrium and maximize the successful pregnancy rate of embryo transfer. Trial registration number not applicable

Cesarean Scar Ectopic Pregnancy: A Do-Not-Miss Diagnosis.

The rate of cesarean section (CS) for delivery has increased internationally, reaching 50% in some countries. Abnormal implantation of a new pregnancy at the site of the prior hysterotomy is an important complication because of the risks of hemorrhage, uterine rupture, and progression to placenta accreta spectrum (PAS), a condition with high morbidity with potential for catastrophic obstetric hemorrhage, maternal and fetal mortality, and loss of fertility. Cesarean scar ectopic pregnancy (CSEP) is the recommended term to describe these pregnancies, which are recognized on the basis of the sac implantation site, growth pattern, and associated abnormal perfusion. The true incidence of CSEP is unknown because the condition is likely underdiagnosed and underreported. The 2022 Society for Maternal-Fetal Medicine consult series notes that severe maternal morbidity and mortality are linked to difficulty in making the diagnosis of CSEP. The authors review the signs of CSEP at imaging, some pitfalls that may lead to delayed or missed diagnosis, and the consequences thereof. CSEPs must be differentiated from low implantation of a normal pregnancy, cervical ectopic pregnancy, and evolving pregnancy loss. Early recognition allows prompt and safe treatment that is usually surgical. Early treatment results in decreased health care costs, a shorter hospital stay, preservation of fertility, and prevention of iatrogenic preterm delivery, which is typical in cases that progress to PAS. Hysterectomy has serious negative psychologic consequences for patients of childbearing age; early diagnosis and prompt treatment of CSEP can prevent this often-ignored complication. ©RSNA, 2024 Supplemental material is available for this article.

A Systematic Review about Cervical Pregnancy and our Experience.

Cervical ectopic pregnancy is a relatively rare type of ectopic pregnancy and has no standardized guidelines for management. This systematic review is based on the collection of case reports, published in PubMed/MEDLINE about the resolution of ectopic cervical pregnancies over the last decade and the presentation of a case managed in our healthcare unit. Studies involving cervical pregnancy in the first trimester with the presence of a viable embryo and β-hCG in the serum below 100.000 mIU/mL were included, while heterotopic pregnancies were excluded. Nineteen articles reporting twenty-three case reports are demonstrated explicitly emphasizing on the management techniques. There is no established approach for the management of this type of ectopic pregnancy. It is important to consider the conservative approaches as first-line treatment in all cases of cervical pregnancy preserving fertility. Minimally invasive methods are also described and preferred as second-line treatment, as reported in our literature review.

Characteristics Associated With Faster Human Chorionic Gonadotropin Resolution in C-Section Scar and Cervical Ectopic Pregnancies After Treatment With Double Balloon Catheter [ID 2683550

INTRODUCTION: C-section scar (CSP) and cervical (CXP) ectopic pregnancies are increasing in frequency and associated with significant maternal morbidity. Recently, double balloon catheter (DBC) has been shown as a successful treatment option, but data are limited regarding timing of human chorionic gonadotropin (hCG) resolution. We aimed to define characteristics associated with decreased time to hCG resolution. METHODS: This is a retrospective cohort study of CSPs and CXPs at a single tertiary center treated with DBC placement between 2018 and 2023. Institutional review board approval was obtained. The primary outcome was resolution of serum beta-hCG less than 5 within 30 days. Predictor variables included initial hCG levels, mean sac diameter, and DBC inflation volume. Multivariable logistic regression was used to adjust for gestational age and initial hCG. RESULTS: Thirty-three pregnancies were included; 13 (39%) had resolution of hCG in less than 30 days and 20 (61%) had resolution in greater than or equal to 30 days. Mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 were significantly associated with hCG resolution less than 30 days (77% versus 40%, aOR 7.18 [95% CI, 1.23–58.8] and 92% versus 60%, aOR 10.38 [95% CI, 1.39–239.98], respectively). There was no significant difference between lower balloon fill amount and hCG resolution. CONCLUSION: After treatment with DBC, most patients require greater than 30 days for hCG resolution. However, patients with mean sac diameter less than 10 mm and initial hCG less than or equal to 25,000 have higher odds of hCG resolution within 1 month, providing a framework for counseling of patients opting for this method.

The relationship between serum levels of epidermal growth factor and β-human chorionic gonadotropin and the type and prognosis of ectopic pregnancy.

This work aimed to explore the relationship between epidermal growth factor (EGF) and β-human chorionic gonadotropin (β-HCG) and ectopic pregnancy types and impact on prognosis. Twenty women with normal pregnancies (NPs) were recruited as control group, and twenty women each with tubal pregnancy (TP) and cervical pregnancy (CP) were recruited. Blood samples were collected to detect EGF and β-HCG. Data on length of hospital stay and incidence of complications were collected. The differences in serum EGF and β-HCG levels were compared among groups and within various types of ectopic pregnancy using analysis of variance and Pearson correlation analysis. Serum EGF and β-HCG were notably lower in TP and CP group vs. controls (P < 0.05). In subgroup analysis within the types of ectopic pregnancy, serum EGF levels were drastically higher in TP group vs. CP group (P < 0.05). Serum EGF levels were negatively correlated with pregnancy outcomes and incidence of complications (P < 0.05). In patients with TP and CP, serum EGF and β-HCG recovery time and hospital stay differed drastically (P < 0.05). Serum EGF and β-HCG levels showed optimal cutoff values identified at 2.65μg/L and 11,745.35IU/L, respectively. The corresponding area under the curve (AUC) values were 0.885 and 0.841. Elevated levels of EGF may be associated with the occurrence of ectopic pregnancy and may impact the type of ectopic pregnancy, pregnancy outcomes, and the incidence of complications. Further clinical research is warranted to investigate these findings.

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.

Medical management of early pregnancy loss with mifepristone and misoprostol in emergency departments compared to a Complex Family Planning office: Implementation of a COVID-19 institutional policy change

ObjectivesTo evaluate the implementation of mifepristone and misoprostol for medical management of early pregnancy loss (EPL) in emergency departments (EDs) by comparing efficacy, complication, and follow-up rates for patients treated in EDs to those in the Complex Family Planning (CFP) outpatient office. Study DesignIn COVID-19's first wave, we expanded medication management of EPL to our EDs. This retrospective study evaluated 72 patients receiving mifepristone and misoprostol for EPL from 4/1/2020-3/31/2021, comparing treatment success, safety outcomes, and follow-up rates by location. We did not perform a power calculation. ResultsThirty-three (46%) patients received care in the ED and 39 (54%) at CFP. Treatment success was lower in the ED (23, 70%) compared to CFP (34, 87.2%), but after adjusting for insurance status and type of pregnancy (miscarriage, uncertain viability, unknown location) this was not significant: aOR 0.48 (95%CI 0.13-1.81), p=0.28. More ED patients underwent emergent interventions (3 vs 0). Complications in the ED cohort included two emergent uterine aspirations, one uterine artery embolization, and two blood transfusions. Among these, two cases were attributed to misdiagnosis (a cesarean scar and a cervical ectopic pregnancy interpreted as incomplete miscarriages) and one to guideline nonadherence (anticoagulated patient). No complications occurred in the CFP group. Follow-up rates were over 80% in both groups. More ED patients engaged in telehealth follow-up (67% vs 18.0%, p≤0.0001). ConclusionsIn this small sample, we observed a trend toward lower rates of treatment success following medication management of EPL in the ED, compared to the CFP office. This analysis highlights that both correctly making uncommon diagnoses and adhering to new guidelines presented challenges during our implementation process. IMPLICATIONSImplementing mifepristone and misoprostol for EPL in our EDs achieved lower rates of pregnancy resolution compared to outpatient management. Complex uncommon diagnoses and implementing new care pathways in EDs may have contributed to complications and highlight opportunities for improvement. Additional studies are needed to further quantify safety outcomes for EPL management in EDs. TWEETABLE ABSTRACTED provision of mifepristone and misoprostol for early pregnancy loss during COVID-19 was less effective than outpatient care. There were more serious complications in the ED group due to misdiagnosis and guideline nonadherence.

Ultrasound Guided Monofetal Aspiration and Cerclage Management of Heterotopic Cervical Pregnancy in In Vitro Fertilization Twins

Ultrasound Guided Monofetal Aspiration and Cerclage Management of Heterotopic Cervical Pregnancy in In Vitro Fertilization Twins

Successful Management of Early Cervical Ectopic Pregnancy with Single Dose Methotrexate

Cervical ectopic pregnancy is an uncommon but a potentially life-threatening condition due to risk of severe haemorrhage and occasional need of hysterectomy. Transvaginal ultrasonogram is a key way to diagnose such a case. Early detection and conservative approach of treatment could limit the morbidity and preserve fertility in many cases. Here, we present a case of cervical pregnancy diagnosed by ultrasonogram at 6 weeks of gestation and treated successfully by a single dose of intramuscular methotrexate. Delta Med Col J. Jan 2021;9(1):58-61

Management of ectopic pregnancy after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer: a case series and mini-review.

Ectopic pregnancy (EP), reflecting a fertilized ovum implanted outside the normal uterine cavity, represents a frequent cause of morbidity and possibly mortality in women of reproductive age. To summarize the diagnosis and treatment of EP after in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). The medical records of patients who were diagnosed with EP after embryo transfer from 2017 to 2019, in a tertiary hospital were reviewed. Of the 24 cases analyzed, 21 (87.5%) had fallopian tube involvement, while 2 (8.3%) and 1 (4.2%) had cornual and cervical pregnancies, respectively. Clinical manifestations included vaginal bleeding (58.3%) and lower abdominal pain (16.7%); 9 (42.9%) cases had no symptoms. One cornual pregnancy was misdiagnosed as acute appendicitis and later correctly diagnosed by laparoscopic exploration. There were 2 cases of multiple-site EP and 2 of heterotopic pregnancy, including one with an intrauterine pregnancy with double chorionic and four amniotic sacs and right tubal ampullary pregnancy. Five of the 21 cases with fallopian tube involvement received conservative treatment, while the remaining 16 underwent surgeries, including laparoscopic ipsilateral salpingostomy and ipsilateral salpingectomy. Ectopic pregnancy after embryo transfer, mainly involving the fallopian tube, is very complex and is with diverse manifestations. Even with the pregnancy sac observed in the uterus, the pelvic cavity should be scanned thoroughly after embryo transfer.

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.

Non-tubal ectopic pregnancy treatment experiences of a tertiary care center.

To evaluate the incidence, the risk factors, and the treatment outcomes of Non-tubal ectopic pregnancies (NTEP) treated in a tertiary care center. A total of 110 NTEP cases treated between 2014 and 2019 were included in the retrospective study. The study cohort was divided into 6 groups according to the pregnancy localization: 87 cesarean scar pregnancies (CSPs), 7 ovarian pregnancies, 6 interstitial pregnancies, 4 rudimentary horn pregnancies, 4 abdominal pregnancies, and 2 cervical pregnancies. One woman rejected all treatment modalities. Demographic characteristics, treatment modalities, and outcomes of each group were evaluated. In the study cohort, expectant management was performed in one (0.9%) woman. The methotrexate (MTX) treatment was administered in 29 (26.3%) women. Seventeen (15.4%) women underwent surgery, and 63 (57.2%) women underwent manual vacuum aspiration (MVA). A woman rejected all treatment modalities. Although 70.1% (n = 61) of CSPs were cured with MVA, 24.1% (n = 21) of them were treated with a single-dose MTX regimen in addition to MVA. The higher mean gestational sac size (33,9 ± 12,96mm vs. 17,34 ± 9,87mm), the higher mean gestational week (8,43 ± 1,16w vs. 6,66 ± 1,49w), the presence of fetal heartbeat (FHB) (90.5% vs. 26,2%) and the history of pelvic ınflammatory disease (PID) (38.1% vs. 6,6%) were found in the CSPs with MVA treatment failure (p < 0.05). The management of NTEPs should be individualized according to the clinical and ultrasonographic findings. The size of the ectopic pregnancy mass, the gestational week, the presence of FHB, and the PID history were the predictive factors for the failure of MVA in CSP cases.

Curative effect of high‐intensity focused ultrasound in management of different types of ectopic pregnancy: A systematic review

AbstractEctopic pregnancy (EP) could be defined as any embryo that got implanted in any site rather than the endometrial cavity. Lately, different types of EP were reportedly managed by high‐intensity focused ultrasound (HIFU). We aimed to pool all available data in a systematic review without meta‐analysis and investigate the efficacy and safety tendencies of HIFU among different types of EP. We applied our comprehensive terms in Google Scholar, PubMed, Scopus, Ovid, and PubMed Central databases from their inception until September 23. Retrieved references were gathered using EndNote in which we omitted the duplicates and exported the record for screening. Data regarding characteristics, safety and efficacy outcomes, and baseline information of the enrolled population were extracted. The eligible case reports were assessed using a tool by Murad and colleagues, while the quality of the included cohorts was appraised using the NIH tool. We retrieved 6637 studies, which were scrutinized by titles and abstracts. We scrutinized the full texts of 36 studies and ultimately included a total of 17 studies. All studies were conducted in China, and on different types of ectopic pregnancy including tubal, cervical, intramural, caesarian scar, and corneal ectopic pregnancy. The mean age of enrolled patients was 33.03 years, and we pooled a total sample of 853 patients. The follow‐up period varied widely among the included studies, ranging from 1.3 months to up to 69 months. Normal menstruation recurred after a mean of 35 days, as reported by nine studies. Most of the included studies reported normal β‐HCG after around 30–40 days. Twelve studies with 757 patients reported a cumulative incidence of 179 cases of abdominal pain after HIFU. Neither of the enrolled patients reportedly complained of skin burn after HIFU. We suggested managing EP patients with HIFU, especially when seeking further conceiving. High‐quality randomized controlled trials are required to draw a stronger level of evidence.

Cervical Cerclage: Prolonging Gestational Period for Successful Pregnancy Outcome

Background: Cervical Cerclage may be an effective treatment option in true cervical insufficiency. Cervical function plays a crucial role to protect growing fetus in utero in maintaining successful pregnancy. As the gestational weeks progress, the cervix undergoes dynamic changes, including softening and shortening, to accommodate fetal growth. Objective: The objective of this study is to evaluate the effectiveness and outcome of cervical cerclage placement as a preventive measure against recurrent pregnancy loss and preterm delivery and its complications, to analyze pregnancy outcomes among participants who received cervical cerclage and to investigate the relationship between cervical cerclage and pregnancy outcome based on gestational age. Method and Materials: The study was conducted over three years at CMH, Jashore and Ibn Sina Hospital Jashore, utilizing a retrospective and longitudinal interventional approach. Ethical approval was obtained before commencing the study, which involved 92 cases undergoing mid-trimester cervical cerclage. Cervical length measurements, cervical cerclage using the McDonald technique, and subsequent medical management were performed with outcome analyzed using descriptive statistics and odds ratio. Data were analyzed retrospectively through SPSS data analysis tool. Result: 45.65% of patients experienced term deliveries, while 33.70% had preterm deliveries, with 20.65% facing abortions. Distinct inclusion criteria unveiled diverse outcomes, such as recurrent pregnancy loss cases showing 40.82% preterm and 38.78% term deliveries. Odds ratios highlighted cervical length's significance, with a 0.25 ratio indicating reduced preterm risk. Interestingly, 61.69% of preterm births occurred between 34 and 36 weeks. Maternal outcomes indicated low incidence rates of hemorrhage (4.8%), infections (1.1%) and cervix laceration (2.4%). Conclusion: The study underscores cervical cerclage's potential in enhancing full-term pregnancies, particularly for patients with cervical incompetence. While highlighting its success, the study also acknowledges associated risks and complications. J Bangladesh Coll Phys Surg 2024; 42: 57-62