Cervical Pregnancy Research Articles

Knowledge, attitudes, and preventive practices towards sexually transmitted infections among youth in Tonga: local evidence to strengthen preventive actions

Background: Sexually transmitted infections (STIs) remain a public health concern due to their profound impact on sexual and reproductive health, particularly in developing countries. Many nations have investigated the root causes of STIs, however, there are limited studies published in the small island developing states in the Pacific, including Tonga. The lack of adequate information in the local context causes significant challenges to the proper planning and effective implementation of STIs prevention and control programs. Aim: This study aimed to assess the knowledge, attitudes, practices, and health seeking behaviours towards STIs among youth in Tonga, with a view to generating local evidence to strengthen preventive policies and targeted interventions. Methods: This cross-sectional study was conducted on a sample of 433 youth aged 15-24 years in Tonga. Interviews were conducted by trained interviewers using a standardised questionnaire that collected information on demographic characteristics, knowledge, attitudes, practices, health seeking behaviours towards STIs and the barriers to accessing sexual health services. The descriptive results and associations between variables were also presented. Results: Of the total youth survey, 233 (54%) were females, 277 (64%) were unemployed, and 399 (92%) were unmarried. Less than half of youth correctly identified HIV, chlamydia, and syphilis as STIs. The percentage of youth who correctly answered the routes of transmission and the symptoms of STIs were low. Infertility (51%) was the most recognised complication, and one third of youth correctly answered that cervical cancer, ectopic pregnancy, and stillbirth are some of the complications. Over 90% of youth perceived that condoms protect against the diseases; however, approximately 30% thought that the use of a condom is not required if both partners have symptoms of STIs and multiple sexual partners play no role in diseases transmission. Of the sexually active youth, only 47% used a condom the first time they had sex. The main reason was the limited availability of condoms. It was reported that 31% of females and 66% of males consumed alcohol, a contributor to risky sexual practices. Less than half of youth reported that they would access clinics if they had symptoms. The main barriers to seeking sexual health services were ‘being too embarrassed’ and issues with privacy at the clinics. Conclusion: This study highlighted the urgent need to strengthen national preventive policies and culturally acceptable targeted interventions to tackle STIs more effectively. The findings also provided a timely reminder to policymakers and health leaders to invest additional resources to effectively prevent and control; incorporate comprehensive and culturally acceptable sexual health education in schools; improve privacy, confidentiality, and accessibility of sexual health services in all relevant health care settings in Tonga.

Uterine artery embolization and local and systemic methotrexate therapy followed by hysteroscopic surgery for management of cervical pregnancy: A case report

Uterine artery embolization and local and systemic methotrexate therapy followed by hysteroscopic surgery for management of cervical pregnancy: A case report

Analysis of the diagnosis and management of cervical ectopic pregnancies in Ecuador, through the study of cases described in the bibliography

Ectopic pregnancy is a condition in which the fertilized egg implants and begins to grow outside the uterus, usually in one of the fallopian tubes. Currently, with the advancement of science, the diagnosis can be made within the first weeks of evolution, after fertilization, identifying the gestational sac in the cervix using ultrasound techniques that seek to implement a measured treatment that does not affect the fertility of the the patient. The objective of the research consists of analysis of the diagnosis and management of cervical ectopic pregnancies in Ecuador, through the study of cases described in the bibliography. The type of research is of a descriptive bibliographic nature, because it seeks to identify the diagnostic tools and clinical criteria described, as well as risk factors described in the bibliography. There are clinical criteria that help detect a cervical ectopic pregnancy such as intense abdominal and pelvic pain, abundant vaginal bleeding, hemorrhages and sensitivity in the area near the cervix. Among the treatment options that exist are medications such as methotrexate or some others that inhibit embryonic growth. In Ecuador this problem is growing and is due to the absence of knowledge about the malformation and the lack of a protocol for its management and resolution, given that there is no established order in how to treat patients with this pathology, causing medical care slows down and generates greater complications

EP27.07: Prophylactic uterine artery embolisation before curettage in cervical pregnancy with placenta previa

EP27.07: Prophylactic uterine artery embolisation before curettage in cervical pregnancy with placenta previa

A rapid clinical deterioration of a cervical exophytic intradural intramedullary sporadic hemangioblastoma diagnosed during pregnancy.

Hemangioblastomas are benign CNS tumors that can occur sporadically or in conjunction with von Hippel-Lindau disease. While 2% of spinal cord tumors are hemangioblastomas, combined cervical hemangioblastomas and pregnancy is rare. Some reports suggest that hemodynamic and hormonal changes in pregnancy might increase hemangioblastoma growth and aggravate symptoms. Urgent tumor removal is required when neurological problems deteriorate after failed symptomatic treatment. Neurosurgeons should collaborate with anesthesiologists and obstetricians in such cases. Herein, the authors present the first known video case of a sporadic cervical hemangioblastoma diagnosed during pregnancy that required urgent surgery due to failed symptomatic treatment and progressive clinical deterioration.

EP27.21: A cervical ectopic pregnancy presenting as a Caesarean scar pregnancy: a case report

EP27.21: A cervical ectopic pregnancy presenting as a Caesarean scar pregnancy: a case report

Optimizing Outcomes Using Multimodal Therapy: Persistent Cervical Ectopic Pregnancy with Cardiac Motion

Optimizing Outcomes Using Multimodal Therapy: Persistent Cervical Ectopic Pregnancy with Cardiac Motion

Cervical ectopic pregnancy – the first case of live birth and uterus-conserving management

A 37-old III gravida II para with two previous cesarean sections (CS) presented in 7 + 3 weeks of pregnancy with cervical ectopic pregnancy (CEP). At 12th week of pregnancy, a cerclage was performed to avoid cervical distention by the expanding placenta. Due to missing experience in CEP management and to avoid emergency operation, we recommended CS in 30th week of pregnancy due to unspecific pain of the patient. Vaginal bleeding never occured.After transverse laparotomy, the urinary bladder was sharply dissected from the anterior uterine and cervical wall. The baby was delivered by transverse cervicotomy caudally of the placenta. The placenta was left in situ. The patient then got prophylactic embolization of the uterine arteries to prevent further severe hemorrhage. 48 h later, ultrasound showed a floating, avascular placenta within a poor echogenic fluid-filled cervical space as well as macrohematuria. After re-laparotomy and cervicotomy at the same day, the placenta was completely and easily evacuated. A bladder injury was recognized and closed. We performed a cervical internal os plasty by inverting the cervical lips and suturing their distal ends on the proximal cervical tissue, resulting in complete bleeding cessation. Although, the patient got 8 erythrocyte concentrates at all, she was always in a stable condition without hemorrhagic shock.This case demonstrates for the first time a live-birth with uterus-conserving management in CEP.

Clinical efficacy and safety analysis of different treatment options for Cervical pregnancy

Objective To compare the efficacy and safety of different treatment options for cervical pregnancy (CP). Materials and methods A total of 74 patients diagnosed with CP at Hunan Provincial Maternal and Child Health Care Hospital between January 2016 and September 2022 were retrospectively analyzed. Among them, 31 were treated with uterine artery embolization (UAE) followed by hysteroscopic curettage, 34 were treated with hysteroscopic curettage alone, and nine were treated with high-intensity focused ultrasound (HIFU) followed by hysteroscopic curettage. Medical records and pregnancy outcomes were analyzed. Results There were no significant differences in age, gravidity, parity, abortion, or preoperative hemoglobin levels among the patients in the three groups; however, significant differences in gestational age, gestational sac diameter, preoperative β-hCG, and presence of cardiac pulsation were observed (p < 0.05). After treatment, there was no conversion to laparotomy, and the uterus was preserved in all patients. Significant differences in blood loss during curettage, hospitalization costs, hospital days, menstrual recovery interval, β-hCG decline rates, retained products of conception, and intrauterine adhesions rate among the three groups were observed (p < 0.05). There were no significant differences in the placement of the uterine Foley balloon, effective curettage rate, pre-and postoperative hemoglobin decline, live birth rate, or proportion of subsequent pregnancies among the three groups. Conclusion Our results showed that hysteroscopic curettage, HIFU, and UAE followed by hysteroscopic curettage are safe and effective for treating patients with CP. Compared with the UAE, HIFU has the advantages of lower hospitalization costs, shorter hospital stays, and shorter menstrual recovery intervals.

Tubal cervical double ectopic pregnancy, missed diagnosis, and lessons from an extremely rare case with a systematic review of literature

ABSTRACT A very rare form of heterotopic pregnancy where one of the ectopic gestational sacs is located in the fallopian tube and the other in the cervix uteri is being presented. Unlike the only other similar case reported, where tubal ectopic was managed with salpingectomy and the cervical ectopic was diagnosed after the salpingectomy, our case was that of missed diagnosis of tubal ectopic while focusing on medical management of the cervical ectopic pregnancy. Management options for such situation are being discussed, and a review on the management of CEP is presented with a focus on conservative medical therapy. Conservative treatment in case of tubal cervical double ectopic may be feasible with early diagnosis after ruling out adverse parameters.

Cervical and Vaginal Deciduosis: Insights on Management and a Systematic Review of Observational Studies on Pregnancy Complications and Management Outcomes (Including Vaginal Birth).

Deciduosis is an ectopic transformation of connective tissue into decidual-like cells. This is the first systematic review describing the clinical course, associated pregnancy complications, and management outcomes of cervical and vaginal deciduosis. Our search covered worldwide observational studies published in English in five databases (PubMed, PubMed Central(PMC), Europe PMC, ScienceDirect, and Google Scholar) from inception to February 24, 2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and critically appraised studies using CAse REport (CARE) and Joanna Briggs Institute (JBI) tools. Then, we extracted patient characteristics, clinical features, management-related information, and outcomes. The selection process identified 15 studies describing 30 pregnancies. Macroscopic cervical and vaginal deciduosis presented as recurrent vaginal bleeding in over 16 of 24 women (57%). Differential diagnoses included miscarriages, cervical pregnancy, placenta previa, and malignancy. Significant antenatal hemorrhages, preterm rupture of membranes, and preterm birth were the most frequent pregnancy complications. Only one of 27 electively performed procedures resulted in biopsy-induced uncontrolled vaginal bleeding (0.04%), suggesting the relative safety of the interventions. Lesion resection led to the cessation of recurrent symptoms in eight of eight patients (100%) compared to eight of 15 women (53%) under observation management. All women with polypoid deciduosis over 1.5 cm entered labor and delivered without complications. We described the clinical course, pregnancy complications, diagnostic-related challenges, management, and associated outcomes in women with macroscopic cervical and vaginal deciduosis. We supported the analysis with the current state of the problem and discovered gaps for prospective studies.

Hysteroscopic removal of a heterotopic cervical pregnancy to preserve a patient’s intrauterine sac

To introduce a case of removing the heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance. Video description of the case and surgical procedure. Hospital affiliated to university. A 35-year-old woman, G7P1A5L1, was admitted with a heterotopic cervical pregnancy 21 days after IVF-ET (the corrected gestational age was 5+2 weeks). The serum β-hCG level was 24,530.00 mIU/ml at the corrected gestational age of 5+3 weeks. The ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5×0.8×0.5 cm, yolk sac visible) and another sac in the intrauterine cavity (1.2×1.2×1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged the removal of the cervical gestational sac and continuing the intrauterine pregnancy to term. After the Institutional Review Board (IRB) approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac. The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved. Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical-related or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The One-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity. Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.

Intra-amniotic and systemic administration of methotrexate with concomitant surgical evacuation of 11 + 5 weeks cervical ectopic pregnancy: a case report

BackgroundCervical pregnancy is a rare type of ectopic pregnancy. The management of cervical pregnancy is challenging because of the rarity of the condition, late presentation, which is associated with increased risk of failed medical treatment, and excessive post-evacuation bleeding that may require hysterectomy. There is no good evidence in the literature regarding the pharmacological management of living cervical ectopic pregnancy of more than 9 + 0 weeks of gestation, and there is no standard protocol on methotrexate doses in these cases.Case presentationWe present this case to describe a concomitant medical and surgical management of a living 11 + 5 weeks cervical pregnancy. The initial beta-human chorionic gonadotropins (ß-hCG) serum level was 108,730 IU/L. The patient received 60 mg of methotrexate intra-amniotically followed by another dose of 60 mg of methotrexate intramuscularly 24 h later. Fetal heartbeats stopped on day 03. On day 07, the ß-hCG was 37,397 IU/L. On day 13, the patient had evacuation of the remaining products of conception with the insertion of an intracervical Foley catheter to minimize the bleeding. On day 34, the ß-hCG was negative.ConclusionThe concomitant use of methotrexate to induce fetal demise along with surgical evacuation may be considered in the management of advanced cervical pregnancy to avoid excessive blood loss, and ultimately hysterectomy.

ДИФФЕРЕНЦИРОВАННЫЙ ПОДХОД К ДИАГНОСТИКЕ И ЛЕЧЕНИЮ АКУШЕРСКИХ КРОВОТЕЧЕНИЙ ПРИ ЭКТОПИЧЕСКОЙ БЕРЕМЕННОСТИ: СЛУЧАЙ ИЗ ПРАКТИКИ

Ectopic pregnancy is a pathological condition in which the implantation of a fertilized egg occurs outside the uterine cavity. According to statistics, the most common localization of ectopic pregnancy is the fallopian tubes (98-99% of cases), while the cervix is a rare implantation site (0.1-0.4%). At the same time, analyzing the complications of the gestational process, we can say that it is cervical pregnancy that increases the risk of bleeding leading to the need for emergency surgery. The article presents a case from clinical practice that characterizes the tactics of diagnosis and treatment in case of suspected cervical pregnancy. The analysis of the management of this pregnancy proved the need for a differentiated approach to each case of ectopic pregnancy. This algorithm contributes to the rapid and accurate diagnosis and development of tactics for management pregnancy with bleeding.

Abdominal pregnancy secondary to uterine horn pregnancy: a case report

BackgroundPregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences.Case presentationWe present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery.ConclusionsAbdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.

Cervical twin ectopic pregnancy: case report and systematic review of literature

Cervical twin ectopic pregnancy: case report and systematic review of literature

Student midwives' perspectives of women's sexual and reproductive health literacy in Turkey

ObjectiveThis study focused on the issues surrounding health literacy in the context of women’s sexual and reproductive health (SRH), the significance and availability of information for midwives and women; and the socio-cultural influences and barriers related to women’s level of health literacy. MethodsA cross sectional on-line survey was distributed to 280 student midwives in their 2nd 3rd and 4th year of a midwifery programme. This paper focuses on the responses from 138 students which were analysed using descriptive and non-parametric tests. ResultsStudent midwives indicated their level of agreement regarding women’s ability to access, understand, and appraise information they received verbally and in written form about the six main SRH topics (namely contraception, STIs, abortion, Pap tests and cervical cancer, and fertility and pregnancy), from their midwife but agreement was much lower regarding women’s access to SRH information from peers and their families. False beliefs were ranked as the most common barrier to accessing information and services. Students ranked being a refugee, being from a rural area, being educated to a primary school level or not formally educated, as having the greatest negative impact on women’s health literacy. ConclusionsFindings from this study indicate the role that the sociocultural background of Islamic culture plays in the disparities in sexual and reproductive health literacy (SRHL) for women from the perspective of student midwives. Our findings indicate the need for future research to focus on women as participants to gain their first-hand experiences of SRHL.

Organ-preserving treatment in progressive cervical pregnancy. A clinical case

This article describes a rare clinical case of progressive ectopic pregnancy in the cervix in a female patient of reproductive age, the incidence of which is less than 1% of all ectopic pregnancies. The exact etiopathogenetic mechanism of cervical pregnancy is still unknown. Misdiagnosis of cervical pregnancy can lead to a fatal outcome with massive bleeding and is associated with the risk of hysterectomy and complete loss of fertility in patients of reproductive age.&#x0D; This article presents the results of a pathoanatomical study confirming the diagnosis and adequacy of the performed therapeutic measures. We demonstrated the complexity of diagnosing this pathology, as well as the possibility and conditions for performing an organ-preserving surgery. The presented clinical case will allow doctors of various specialties to know more about this rare form of ectopic pregnancy, to suspect and successfully diagnose cervical pregnancy in the early stages of gestation, which will avoid or reduce the development of severe and sometimes life-threatening complications.

Cervical molar pregnancy, profuse bleeding and urgent surgical treatment.

The association of cervical pregnancy and gestational trophoblastic disease is extreme rare, but it is obvious that such combination is associated with devastating effects on future fertility. We present a case of the patient with cervical molar pregnancy, who was admitted due to hemorrhagic shock caused by profuse metrorrhagia at 7th gestational week. Slightly enlarged uterine corpus, with bulky cervix and normal adnexa were found on laparotomy. Total abdominal hysterectomy with the conservation of one ovary was performed. Pathohistological examination confirmed cervical molar pregnancy. In the case of an ectopic, molar or ectopic molar pregnancy, the early visit to gynecologist would give the opportunity to plan the treatment and to preserve the uterus for further pregnancies.

Treatment of Cesarean Scar and Cervical Pregnancies Using the Ovum Aspiration Set for Intrachorial Methotrexate Injection as a Conservative, Fertility-Preserving Procedure.

Background and Objectives: Cesarean scar and cervical pregnancies are rare forms of ectopic pregnancies, occurring in 1 in 2000 and 1 in 9000 pregnancies, respectively. Both entities are medically challenging due to their high morbidity and mortality potential. Materials and Methods: In this retrospective study, we analyzed all cesarean scar and cervical pregnancies from 2010 to 2019 in the Department of Gynecology and Obstetrics of the University Hospital Freiburg, treated with both intrachorial (using the ovum aspiration set) and systemic methotrexate application. Results: We identified seven patients with a cesarean scar and four patients with cervical pregnancies. At diagnosis, the median gestational age was 7 + 1 (range: 5 + 5-9 + 5) weeks and the mean value of ß-hCG was 43,536 (range: 5132-87842) mlU/mL. On average, one dose of intrachorial and two doses of systemic methotrexate were administered per patient. The efficacy rate was 72.7% with three patients (27.3%) needing an additional surgical or interventional procedure. The uterus was preserved in 100% of the patients. Out of the eight patients with follow-up data, five reported subsequent pregnancies (62.5%) that resulted in six live births. None had recurrent cesarean scars or cervical pregnancies. In the subgroup analyses, when comparing cesarean scar pregnancies to cervical pregnancies, patient characteristics, treatment modality, and the outcome did not differ significantly, except for parity (2 versus 0, p = 0.02) and the duration since the last pregnancy (3 vs. 0.75 years, p = 0.048). When comparing cases with successful and failed methotrexate-only treatments, the maternal age was significantly higher in the successful group (34 vs. 27 years, p = 0.02). Localization of the gestation, gestational and maternal age, ß-hCG, and history of preceding pregnancies were non-predictive for the efficacy of the treatment. Conclusions: The combined application of intrachorial and systemic methotrexate for the treatment of cesarean scar and cervical pregnancies has been proven effective, well-tolerated, organ- and fertility-conserving with a low complication rate.