Cervical Pregnancy Research Articles

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.

Cervical ectopic pregnancy patient treated with intramuscular methotrexate who subsequently had live birth: A case report and literature review

Cervical ectopic pregnancy (CP) is a rare form of ectopic gestation. It is associated with high morbidity and mortality if not properly managed. Transabdominal ultrasonography (TAS) alone without transvaginal ultrasonography (TVS) could create diagnostic dilemmas. Minimally invasive treatment with local or systemic methotrexate is effective and has no effect on subsequent reproductive carrier. We present a 39-year-old G5P2+2 woman who presented with pregnancy of unknown location following TAS. The TVS confirmed CP. She had a successful medical treatment with a single dose of intramuscular methotrexate and subsequently got pregnant and delivered a live-born infant 11 months after treatment.

Ring of fire sign in cervical ectopic pregnancy

Ring of fire sign in cervical ectopic pregnancy

Gestational choriocarcinoma of the cervix – a case report

Cervical primary choriocarcinoma is an extremely rare condition that should be considered in the differential diagnosis of a cervical abnormal bleeding, especially due to intense vasculature, mainly in young women. We present the case of a 31-year-old Caucasian patient, para 2, presenting a cervical well vascularised tumor in the uterine cervix, causing vaginal bleeding that occurred after an evacuated uterine curettage and hemostatically for incomplete abortion. The diagnosis of suspected cervical pregnancy was established based on the imaging aspect: the transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network. For differential diagnosis, serum β-hCG dosing was recommended, which had a value of 2110 mUI/ml. The histopathological results correlated with elevated levels of β-hCG suggested the diagnosis of choriocarcinoma. Full interaxial hysterectomy was performed. Choriocarcinoma has a very good prognosis, even in advanced stages, because it is a very chemosensitive tumor.

Contrast-enhanced Ultrasonography: A New Strategy to Confirm Cervical Pregnancy

Contrast-enhanced Ultrasonography: A New Strategy to Confirm Cervical Pregnancy

The clinical effect of Cold-Knife Conization in patients with early cervical cancer and its influence in the pregnancy outcome

Objective To study the clinical effect of Cold-Knife Conization (CKC) in patients with early cervical cancer and its influence in the pregnancy outcome. Methods 40 early cervical cancer patients of adopting the CKC from January 2010 to September 2012 in our Department were selected as observation group.40 early cervical cancer patients without history of cervical conization were selected as control group. All patients were followed up for 8 to 36 months. Tumor recurrence, pregnancy and maternity history and pregnancy outcomes were recorded and compared between groups. Results In the observation group, 32 cases were pregnant (the success rate of pregnancy was 80.0%), of which 4 cases were aborted and the delivery rate was 87.5%. In the control group, 39 cases were pregnant(the success rate of pregnancy was 97.5%) , no abortion was found, and the delivery rate was 100.0%. The pregnancy rate and delivery rate in the observation group were lower than those in the control group (P 0.05). The observation group had 8 cases (28.6%) premature delivery, 9 cases (32.1%) neonatal asphyxia, 6 cases (21.4%) premature rupture of membranes, and the average weight of neonates was (2 842.17±48.99)g. The control group had 3 cases (7.7%) premature delivery, 1 case (2.6%) neonatal asphyxia, 2 cases (5.1%) premature rupture of membranes, and the average weight of neonates was (3 243.81±51.02)g. The perinatal premature birth rate, neonatal asphyxia rate and premature rupture rate of membranes in the observation group were higher than those in the control group, and the average weight of newborns was lower than that in the control group, with statistically significant difference (P<0.05). During the follow-up period, the recurrence rate of the observation group was lower than that of the control group [2.5% (1/40) vs 17.5% (7/40)], with statistical significant significance (P<0.05). Conclusions Although cold knife conization can reduce the recurrence rate of early cervical cancer patients, the fertility and pregnancy outcomes of patients after operation is greatly affected. Careful selection should be made in clinical treatment according to the actual situation. Key words: Uterine cervical neoplasms/SU; Electrosurgery; Neoplasm recurrence, local; Pregnancy outcome

Cervical Ectopic Pregnancies after Spontaneous Conception: Case Reports

Cervical pregnancy (CP) is a rare form of ectopic pregnancy (&lt; 1%) located on the lining of the endocervical canal with frequency at about 1 in 1 000 to 1 in 18 000 deliveries. Cervical gestation is extremely rare beyond 20 weeks and there are few reports in the literature of vaginal live birth with a high mortality risk. Awareness and early diagnosis is essential due to the possibility of a life-threatening hemorrhage, treated with hysterectomy in the past. Cervical ectopic pregnancy can be mistaken on ultrasound examination with similar pathologies and due to the differences in the management and the outcome an accurate diagnosis is of a great importance. Authors describe two cases of ectopic pregnancies in the isthmico-cervical region successfully terminated with a nonsurgical approach.

Early diagnosis of cervical ectopic pregnancy after in vitro fertilization

The rare case of ectopic (cervical) pregnancy after in vitro fertilization is presented. Early ultrasound detection helped to save reproductive function. Differential ultrasound criteria of cervical pregnancy and modern treatment strategy are discussed.

Combined Treatment Techniques in Women with Cervical Ectopic Pregnancy: 58 Cases

Objective: To evaluate current strategies for preserving fertility in patients with cervical pregnancy.

Risk Factors for Cervical Ectopic Pregnancy

Risk Factors for Cervical Ectopic Pregnancy

Methotrexate Therapy for Ectopic Pregnancies: A Tertiary Center Experience.

Our aim is to demonstrate the importance of methotrexate (MTX) therapy for the treatment of ectopic pregnancy (EP). This retrospective study consisted of 99 patients (72 tubal EPs, 20 pregnancies of unknown location (PUL), 4 cesarean section (CS) scar EPs and 3 cervical EPs) treated with MTX. Methotrexate therapy was successful in 68.5% of EPs. There were statistically significant differences between the MTX success and failure groups based on ultrasonographic findings, patient complaints, gestational week and serum human chorionic gonadotropin (hCG) values. The MTX success rates in PUL and tubal pregnancies were 95% and 61.1%, respectively. The MTX success rates in single-dose, two-dose and multi-dose protocol groups were 86.9%, 28.6% and 40%, respectively. All cervical and CS scar ectopic pregnancies were treated successfully with MTX therapy. Methotrexate might be the first-line treatment option for EPs under certain conditions. Physicians must be more cautious in cases with higher hCG values, the presence of abdominal-pelvic pain, the presence of fetal cardiac activity, larger gestational sac (GS) diameters, and more advanced gestational weeks according to the last menstrual period.

OC19.04: Minimally invasive treatment of Caesarean scar and cervical pregnancies using a cervical ripening double balloon catheter: expanding the clinical series

OC19.04: Minimally invasive treatment of Caesarean scar and cervical pregnancies using a cervical ripening double balloon catheter: expanding the clinical series

EP16.09: 3D diagnosis of heterotopic cervical pregnancy: case report

EP16.09: 3D diagnosis of heterotopic cervical pregnancy: case report

Multidisciplinary approach in the treatment of cervical-cervical and cervical pregnancies with the use of modern low-invasive x-ray endovascular technology

Multidisciplinary approach in the treatment cervical ectopic pregnancy has been developed, it includes the systemic use of methotrexate, the embolization of uterine arteries and follow-up fetal egg remove. The new method of combination treatment of cervical pregnancy of one-stage use of embolization uterine artery and temporary balloon occlusion of the internal iliac arteries was applied for the first time in Russia. This algorithm helps to preserve the reproductive function of women.

Conservative treatment of abnormally located intrauterine pregnancies (cervical and cesarean scar pregnancies): a multicenter analysis (Polish series)

Objectives: To analyze the effectiveness and outcome of conservative treatment in cases of abnormally located intrauterine pregnancies (cervical and cesarean scar).Study design: A retrospective analysis was performed of 30 pregnant women hospitalized due to abnormally located intrauterine pregnancies. The analyzed group comprised 24 pregnant women with abnormally located pregnancies. The patients were divided into two groups: the first group consisted of patients treated systemically with methotrexate, while the second of those treated locally by administration of methotrexate (MTX) and/or potassium chloride (KCl) by gestational sac puncture.Results: The analyzed group comprised 24 pregnant women with abnormally located pregnancies. Eight patients were diagnosed with cervical pregnancy (CP) and 16 patients were diagnosed with cesarean scar pregnancy (CSP). Six patients were excluded from the study: two with spontaneous abortions, two heterotopic pregnancies, and two cornual pregnancies. Twelve analyzed patients underwent MTX systemic administration (five patients with CP, seven with CSP). In five patients, systemic treatment was ineffective; they were qualified for additional local therapy with gestational sac (GS) puncture and MTX or KCl administration to the sac and additional administration of MTX to the trophoblast area. In second group of 12 patients (three CP, nine CSP), local treatment (GS puncture with MTX or MTX + KCl) was used as the first line treatment. One patient underwent combined treatment (local + systemic).Conclusions: Conservative treatment should be the gold standard procedure in abnormally located intrauterine pregnancies. It is noticeable that MTX / KCl is more effective in a direct administration to the GS. In four cases, systemic MTX did not produce the desired effects. In these cases, the treatment was assisted by local administration of MTX or KCl, resulting in the termination of an abnormally located pregnancy.

Laparoscopic Management of Cervical Ectopic Pregnancy with Devascularization

Laparoscopic Management of Cervical Ectopic Pregnancy with Devascularization

Novel surgical approach for treatment of cervical ectopic pregnancy in IVF patient

Novel surgical approach for treatment of cervical ectopic pregnancy in IVF patient

Minimally Invasive Treatment of Cesarean Scar and Cervical Pregnancies Using a Cervical Ripening Double Balloon Catheter: Expanding the Clinical Series.

The efficacy of treating cesarean scar pregnancies and cervical pregnancies with the Cook® cervical ripening balloon catheter, in a multicenter office-based setting is reported. Thirty-eight women were treated. Insertion of the catheter was performed under real-time ultrasound guidance. Patients received adjuvant systemic methotrexate, prophylactic oral antibiotics, and oral pain medication. Serum human chorionic gonadotropin and ultrasound scans were followed serially until resolution. Thirty-seven patients were successfully treated, requiring no further procedures. We found that the Cook cervical ripening balloon technique is a simple, effective, outpatient, minimally invasive treatment with few complications noted in this expanded series.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P52. Cervical epidural steroid injections: incidence and determinants of subsequent surgery

BACKGROUND CONTEXT Cervical epidural steroid injections (CESIs) are increasingly used in the nonsurgical management of cervical disorders despite conflicting evidence for efficacy. The proportion of patients who delay or avoid surgery with lumbar or cervical ESIs varies widely in the literature, and contradictory determinants of subsequent surgery have been described. PURPOSE The goals of this study were to determine (1) the incidence of surgery following CESI, (2) the time between CESI and subsequent surgery, and (3) the factors associated with progression to surgery following CESI. STUDY DESIGN/SETTING Retrospective analysis of deidentified administrative claims data. PATIENT SAMPLE A national outpatient and inpatient database from 2007 to 2014 was reviewed, containing 149million unique patients from 2007 to 2014. Inclusion criteria were CESI for diagnoses of cervical disc herniation, myelopathy, radiculopathy, or stenosis, and active enrollment for 1 year prior to the CESI to screen for exclusion criteria. Exclusions include prior cervical surgery, associated neoplasm, pregnancy, inflammatory spondyloarthropathies, fracture (pathologic, nonunion, stress or acute), or infection (abscess, discitis or osteomyelitis). OUTCOME MEASURES The incidence of subsequent surgery and overall survival, measured as the time from CESI to surgery. METHODS Patients were followed longitudinally for up to 6years until they either underwent cervical surgery or had a lapse in health plan enrollment, at which time they were censored. Survival analyses were performed. The rate of surgery and overall survival following CESI were assessed with the Kaplan-Meier survival curve and 95% confidence interval (CI), and factors associated with subsequent surgery were assessed with multivariable Cox proportional hazard models (p RESULTS A total of 44,621 unique CESI patients met the inclusion and exclusion criteria (age 50.1±10.7years, 51.3% female). Forty-eight percent of patients underwent more than 1 CESI, 94.3% of which occurred within 1 year. Within 6 months of CESI, 12.2% (95% CI: 11.9%, 12.5%) of patients underwent surgery, increasing to 15.3% (95% CI: 15.0%, 15.7%) within 1 year and 22.2% (95% CI: 21.7%, 22.8%) within 5years. The factors associated with subsequent surgery were age, diagnosis, number of CESIs, depression, chronic obstructive pulmonary disease, alcohol use, U region, and rural versus urban location. Cardiac comorbidities other than congestive heart failure or infarction had lower risk for surgery. Patients with radiculopathy were less likely to progress to surgery following CESI than stenosis or herniation. Additional CESIs reduced the risk for subsequent surgery, with 75% (95% CI: 57%, 95%) higher risk with 1 versus 4 CESIs (p CONCLUSIONS Following CESI, 22.2% of patients underwent surgery within 5years. Multiple patient-specific risk factors for subsequent surgery were identified, and patients undergoing repeated injections were at lower risk of proceeding to surgery. Additional analyses comparing matched cohorts of surgical patients with and without prior CESI will further advance our understanding of the value and risks of CESI.

Successful conservative management in cervical Ectopic Pregnancy

Incidence of cervical ectopic pregnancy is 6% of all the ectopic pregnancies. And this percentage is rising since last decade with increased incidence of ectopic pregnancies in general. Assisted reproduction, tubal pathology due to pelvic inflammatory disease or/and adhesions due to surgery are leading causes for increased incidence of ectopic pregnancy. Modern diagnostic techniques and regular follow up in assisted reproduction cases, pick up ectopic pregnancy at an earlier gestation. Previously hysterectomy was the only resort in majority if not all the cases of cervical ectopic pregnancies But now in selective cases like saving fertility in a patient a promising management has emerged It is however emphasized that appropriate treatment option - medical or surgical should be considered according to individual case. This case of ectopic cervical pregnancy at 6 weeks of gestation is managed successfully by conservative management.