Cervical Pregnancy Research Articles

Combined Minimally Invasive Approach to Preserving Fertility in Patients with Cervical Pregnancy

Study Objective Assess the feasibility of the minimally invasive methods in preserving the fertility in patients with cervical pregnancy. Design Canadian Task Force: Level II-2 Prospective and retrospective analysis. Setting Department of Operative Gynecology, V.I Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; Moscow, Russian Federation. Patients or Participants 66 women with cervical pregnancies desiring preservation of fertility (ages 25-44 years), treated at the Department of Operative Gynecology during the past 13 years. Interventions Standard diagnostic clinical protocol was carried out in all patients. Patients with cervical pregnancy received intravenous methotrexate at an average of 50 mg/every 48 hours and 6 mg of intramuscular leucovorin rescue injection at 28 hours after methotrexate administration followed by resectoscopy or combined selective uterine embolization and resectoscopic approach. 2 women with massive bleeding on admission required hysterectomy. Measurements and Main Results The gestational age on admission ranged from 5 to 11 weeks with mean gestational age being 6.8 ± 0.8 weeks. 64 women underwent combined therapy with preoperative systemic methotrexate and resectoscopic excision. 28 of these patients had chorionic invasion into the cervix and required selective uterine artery embolization (SUAE), followed by resectoscopy. 2 patients with massive bleeding underwent emergent hysterectomy. Uterus preserving surgical procedures were started when a decreasing levels of β-hCG of 4000-7000I U/l were demonstrated. Bilateral SUAE was utilized in 28 cases, through the right femoral approach (12 cases) and through the right radial artery (16). The blood loss in all cases was less than 25 cc, including the ones with chorionic invasion. Conclusion The results of our study suggest that resectoscopic removal of embryos with previous cytostatic therapy with methotrexate allows for the preservation of fertility in young women with early cervical pregnancy. SUAE provides minimal operative blood loss and shorter hospital stay, and preserves reproductive potential in women with chorionic cervical invasion.

VP52.27: The association between cervical elastography and adverse pregnancy outcome in singleton pregnancy with short cervix and funnelling undergoing progesterone treatment

VP52.27: The association between cervical elastography and adverse pregnancy outcome in singleton pregnancy with short cervix and funnelling undergoing progesterone treatment

Shifting Outcomes for Cervical Ectopic Pregnancies Using Characteristic Transvaginal Ultrasound Findings

Shifting Outcomes for Cervical Ectopic Pregnancies Using Characteristic Transvaginal Ultrasound Findings

Survival of the fetus: cervical cancer and pregnancy, a challenging combination

Survival of the fetus: cervical cancer and pregnancy, a challenging combination

Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience.

Non-tubal ectopic pregnancies (NT-EPs) are rare but potentially life-threatening conditions. The incidence ranges are between 5–8.3% of all ectopic pregnancies. For this retrospective observational study, 16 patients with NT-EP and treated from January 2014 to May 2020 were recruited. Demographic details, symptoms, Beta human chorionic gonadotrophin (β-hCG) levels, ultrasound findings, management and treatment outcomes were presented. In hemodynamically stable patients, diagnosis was made using ultrasounds and β-hCG levels. Laparoscopy was essential to identify and remove the ectopic pregnancy in clinical unstable patients. A radical laparoscopic approach was chosen in one case of cervical pregnancy diagnosed late in the first trimester. Medical treatment and minimally invasive procedure, alone or combined, resulted in effective strategies in asymptomatic women with an early diagnosis of NT-EP. We report cases of cervical pregnancies successfully treated by hysteroscopy alone or combined with medical treatment, the first case of scar pregnancy treated by mini-reseptoscope and curettage and the fifth case of interstitial pregnancy treated with Methotrexate and Mifepristone. In this manuscript we report a single center experience in the management of NT-EPs with the aim of outlining the importance of the early diagnosis for a minimally invasive treatment in order to reduce maternal morbidity and mortality and preserve future fertility.

Successful treatment of a cervical ectopic pregnancy with single-dose methotrexate therapy

Ectopic pregnancies implanted in the cervix account for less than 1 percent of all extra-uterine pregnancies. Due to the limited incidence of cervical ectopic pregnancies, there are no established guidelines for medical versus surgical management. We report a case of a cervical ectopic pregnancy with a fetal heartbeat successfully treated with single dose methotrexate therapy.

Successful Transvaginal Microwave Ablation of a Heterotopic Cervical Pregnancy. A Case Report

Heterotopic cervical pregnancy is a rare and potentially dangerous condition where the challenge is the removal of the ectopic pregnancy while preserving the intrauterine one. We present the case of an otherwise healthy 36-year-old woman with heterotopic cervical pregnancy after an IVF cycle for tubal infertility. At 6.5 weeks after a consultation with gynecologists and interventional radiologists, the patient agreed to undergo microwave ablation of the cervical pregnancy. Monthly ultrasound examination showed the persistence of non homogeneous and vascularized tissue in the cervix. Intrauterine pregnancy continued without complications until 37 weeks when a cesarean section was performed for sudden and profuse bleeding, in the presence of uterine contractions. A healthy baby girl was delivered, and the postoperative course was otherwise uncomplicated. Heterotopic cervical pregnancies are rare, and no consolidated and risk-free treatments are available at the moment. Here, we present a case of heterotopic cervical pregnancy treated successfully and without complications with microwave ablation.

Cervical ectopic pregnancy, conservative management, report of two cases and review of the bibliography

Ectopic pregnancy represents around 1% of all pregnancies, it is considered an entity of difficult conservative management, in patients who wish to preserve fertility, in the context of hospitals, which cannot offer approaches with minimal invasion such as hysteroscopy, without However, conservative treatment with cervical balloon placement, clamping of the uterine arteries with the ZEA technique, and doses of methotrotexate have been documented. Cases with meted handling.

Comment je fais…le diagnostic d’une grossesse cervicale

Comment je fais…le diagnostic d’une grossesse cervicale

Managing Ectopic Pregnancies by Targeting Chorionic Villi with a Transvaginal Injection of Ethanol into the Lacunar Space.

Methotrexate has been the main mode of non-surgical treatment for ectopic pregnancies. However, we have developed an easier, repeatable method that can be applied even to patients with a high beta-human chorionic gonadotropin (β-hCG) level and/or positive fetal heartbeat, by targeting chorionic villi with a transvaginal injection of absolute ethanol (AE) into the lacunar space (intervillous space). The efficacy and safety of this method were examined in 242 cases of ectopic pregnancy, including 103 with positive fetal heartbeat. Serum β-hCG level was measured at frequent intervals, and transvaginal ultrasonography was performed to observe the gestational sac and hyperechoic inner ring. Of the 242 patients, 222 (91.7%) were successfully treated. The average number of AE injection(s) required was 1.6 (range: 1–5), and the average dose was 3.2 mL. After the treatment, many of the patients tried to conceive again, and 63 of the traceable 145 patients (43.4%), who had fallopian tube pregnancy, and 7 of the traceable 12 patients (58.3%), who had cervical or cesarean scar pregnancies, successfully conceived and delivered babies with no observed side effects. Therefore, this method could be an effective treatment for ectopic pregnancy with the potential to replace conventional surgical interventions and medical treatment using methotrexate.

Cervical ectopic pregnancy misdiagnosed as an incomplete miscarriage - a steep learning curve

Cervical ectopic pregnancy misdiagnosed as an incomplete miscarriage - a steep learning curve

Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography.

AimTo assess the effect of ultrasound-guided cervical dilation on clinical pregnancy rates in women with cervical stenosis.MethodsA prospective case control study was conducted in women with unexplained infertility. These women underwent saline infusion sonography and were suspected of having cervical stenosis if a 7 French Foley’s catheter could not be introduced into the cervical canal. Women with suspected stenosis who agreed to undergo ultrasound guided dilation were included as cases. Those with suspected stenosis who refused dilation were used as controls. Both groups were followed for one year. The primary outcome measure was women who had clinical pregnancy i.e. fetal heart beat present on transvaginal scan during the follow up period.ResultsDuring the study period, 1097 women who underwent SIS were included. A total of 117 (10.7%) patients had cervical stenosis. No statistically significant difference was there in both groups in terms of mean age (p = 0.617), mean body mass index (p = 0.598), duration of infertility (p = 0.588) and type of infertility (p = 0.167). However, both groups were significantly different in terms of history for risk factors i.e. endometriosis (p <0.001), prior surgery (p <0.001), polyps (p = 0.004) and pelvic inflammatory disease (p = 0.001). Eighty-nine women agreed to have dilation and were used as cases and 28 women refused and were used as controls. Of the cases, 70.45% conceived as compared to 18.5% of controls. The mean time to conception in months was also significantly lower in cases (8.10 ± 3.43 vs. 11.39 ± 1.97, p <0.001).ConclusionsOur study shows that ultrasound-guided cervical dilation in women with cervical stenosis can lead to improved conception rates.

Ectopic Cervical Pregnancy: Treatment Route.

Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Results: In one patient treated by hysteroscopy alone it occurred a profuse vaginal bleeding with necessity for blood transfusion. Haemorrhage was controlled by a second hysteroscopic procedure. No complications, such as vaginal bleeding, were recorded in the other cases. Serum β-hCG levels become undetectable in a range of 15–40 days after hysteroscopic management; after medical treatment it become undetectable after 35 days. Serum βhCG levels had a faster drop the day after hysteroscopy than post medical management. The onset of a spontaneous pregnancy at the normal implantation site occurred after five months in one case treated by hysteroscopy. Conclusions: Many therapeutic approaches are effective for CP treatment. Hysteroscopy, alone or in combination with MTX, may provide a greater effect on the descent of βhCG, leading to a reduction of the hospitalization stay, decreasing costs and period for attempt pregnancy. Further prospective studies on larger samples are needed to define therapeutic protocols for CP management.

Ectopic pregnancies after assisted reproductive technologies

Introduction: One of the complications of assisted reproductive technologies (ART) is development of pregnancy beyond the endometrium of the uterine cavity - ectopic pregnancy (EP). There are different factors that influence the frequency of EPs after ART-. On the one hand, the characteristics of ovarian hyperstimulation, and on the other - women's age, hormonal status, history of previous pregnancy, etc. Aim: This is a retrospective study, whose purpose is to examine and evaluate different risk factors in women with EP after ART. Materials and Methods: This is a retrospective study conducted between 01.2013 and 12.2017 at the Dr. Shterev Medical Complex, Sofia. We have analyzed 5229 cycles - 3773 IVF/ICSI cycles, 875 FrET cycles, and 581 cycles with egg donation. A total of 1712 clinical, intrauterine, ectopic and heterotopic pregnancies after ART were included in our study. Results and Discussion: The rate of EPs after ART in our group was 2.4%, which corresponds to previous data, published in the scientific literature. We have also identified some rare forms of EP - cornual and cervical pregnancy. The analysis we conducted showed that probable risk factors for EP are tubal infertility and associated chronic inflammatory processes of the fallopian tubes, increased number of transferred embryos, use of additional techniques - assisted hatching, polycystic ovary syndrome (PCOS), and previous surgery in the pelvis. Conclusion: EP is a global medical emergency and its incidence increases following treatment of infertility. Early diagnosis and prompt intervention are crucial in order to diminish the morbidity and mortality, and to avoid complications thereafter.

Effectiveness of conservative medical treatment for non-tubal ectopic pregnancies: a multicenter study

ObjectiveTo assess the effectiveness of conservative treatment for the management of non-tubal ectopic pregnancies (NTEP) MethodsRetrospective cohort study in three centers (two referral centers) of patients managed for NTEP diagnosed by 2D or 3D ultrasonograhy. Patients underwent one of the following: expectant management, systemic methotrexate (MTX) injection, local MTX injection, combined MTX injection (local and systemic), local injection of hyperosmolar glucose, or misoprostol administration. The primary endpoint was final success defined by resolution of hCG level without need for emergency surgical treatment. Sixty-four patients diagnosed with NTEP were included: 37 (57%) had an interstitial pregnancy, 23 (35.9%) a cesarean scar pregnancy, two (3.1%) a cervical pregnancy and two (3.1%) an ovarian pregnancy. ResultsSix patients (9.4%) underwent expectant management, 24 (37.5%) a systemic MTX injection, 28 (43.8%) a local injection of MTX, three (4.7%) a combined MTX injection, one (1.6%) a local injection of hyperosmolar glucose (1.6%), and two (3.1%) were administered misoprostol. The median age was 32 years (22-45) and mean follow-up was 41 months. The final success rate overall was 92.2%: 100% for expectant management, 87.5% for systemic MTX, 96.4% for local MTX, 100% for combined injection of MTX, 100% for local injection of hyperosmolar glucose, and 50% for misoprostol. No patient required a hysterectomy. Nine (14.1%) patients required surgery, including five (7.8% (5/64)) following a rupture of the NTEP. ConclusionsOur results suggest that conservative medical management of NTEP is effective and safe and should be the first-line treatment for pauci-symptomatic patients with an NTEP.

Combination of conservative treatment and temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection for cervical pregnancy: A retrospective study

IntroductionWe investigated whether temporary bilateral laparoscopic uterine artery clipping with hysteroscopic transcervical resection (LUA clipping-TCR) is an effective minimally invasive treatment for the management of cervical pregnancy. Materials and methods: This study is a retrospective clinical case series conducted at Teine Keijinkai Hospital from January 2014 to June 2019. Nine cervical pregnancies among 164 ectopic pregnancies were retrospectively examined. The intervention involved performing LUA clipping-TCR on villous tissue. Information on patient characteristics, clinical data, and surgical details was collected from medical records and surgical videos. ResultsThe mean (range) age of the patients was 33 years (29–41 years); and mean gestational sac diameter, 12.8 mm (5–24 mm). Five patients had a history of intrauterine procedures. Three patients had a positive fetal heartbeat. The mean (range) preoperative serum hCG level (mIU/mL), surgical time (min), uterine artery blocking time (min), and amount of surgical blood loss (ml) were 14,040 (2880–41,367), 82 (62–120), 42 (21–68), and 57 (10–200), respectively. The mean decrease in serum hCG level (second postoperative day) and duration until resumption of menstruation were 79.7 % (70–86.7 %) and 46 days (35–80 days), respectively. The hospitalization period was 2–3 days, with no evidence of persistent ectopic pregnancy. Live birth was achieved in four cases. DiscussionOur results confirm previous findings and provide new evidence that LUA clipping-TCR is effective for cervical pregnancy management and fertility preservation, respectively. Future large-scale prospective studies to compare different cervical pregnancy management methods are required.

Successful Management of Cervical Ectopic Pregnancy: A Case Report

Background: Cervical ectopic pregnancy is a rare condition with an incidence of less than 0.1% in all ectopic pregnancies. This life-threatening condition is associated with a high morbidity and mortality rates. Recently, the recommended protocol for the treatment of cervical ectopic pregnancy is fertility preservation rather than invasive surgery and hysterectomy. The aim of this report was to introduce a case of successful management of cervical ectopic pregnancy. Case report: A 31-year-old woman was presented with her third pregnancy with a history of one cesarean section and spontaneous abortion. She was admitted to an academic hospital with vaginal bleeding following 10 weeks of amenorrhea. Based on transvaginal ultrasound, a live fetus of about nine weeks was reported, located in the cervical canal. The β-subunit of human chorionic gonadotropin (βhCG) titer was reported as 108000 mIU/m. Cervical pregnancy diagnosis was consistent. In order to preserve fertility based on the patient’s hemodynamic status, medical treatment and surgical intervention, including methotrexate and then intravaginal ligation of cervical branches of uterine arteries, and subsequently cervical tampon was successfully performed. Conclusion: The early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial βhCG titer can be a valuable approach. Appropriate and conservative management has decreased the morbidity rate and preserved the ongoing fertility in the affected patients.

Low lying gestation sac in early pregnancy-an algorithmic approach with ultrasound markers

The differential diagnosis of low lying gestational sac in ultrasound at early pregnancy scan varies from benign entities like cervical stage of miscarriage to morbid conditions like caesarean scar pregnancy and cervical pregnancy. Abnormal placental invasive pregnancies also manifest as low lying gestational sac at cervico-isthmic junction. Early diagnosis using simple ultrasound criteria can prevent severe life-threatening complications. Various clues on ultrasonography can easily differentiate between a caesarean scar pregnancy, cervical pregnancy, cervical stage of miscarriage or a low implanted sac which may be a precursor for morbidly adherent placenta. In this article we have reviewed the ultrasound markers in a case of inevitable abortion, a case of cervical pregnancy, 3 cases of caesarean scar pregnancy and 2 cases of morbidly adherent placenta. Comparison of anterior myometrial thickness in a low implantation of sac and caesarean scar pregnancy has been demonstrated. Sometimes a small cervical polyp can mimic a low lying gestation sac and the differential diagnosis with ultrasound has been discussed. Three dimensional ultrasound examinations for spatial location of the sac provide additional information for further management and aids in precise diagnosis. Though other investigations like MRI may also be beneficial in arriving at a diagnosis, its routine usage may be limited due to the cost and availability. Hence defining ultrasound markers in a low lying gestational sac helps in early diagnosis which can prevent fertility losses incurred due to inadvertent management

Intrauterine ectopic pregnancy - ultrasound typing and treatment.

To analyze the correlation between ultrasound typing and treatment modality of patients with an intrauterine ectopic pregnancy (cervical and cesarean scar). We retrospectively enrolled 65 patients diagnosed with cesarean scar pregnancy (CSP) or cervical pregnancy (CP) between February 2014 and May 2018. The cases were divided into two types according to the ultrasound presentation with a gestational sac (GS, type I) or a heterogeneous mass (HM, type II). Type I was further divided into type Ia (< 8 weeks) and type Ib (≥ 8 weeks); type II was defined as type IIa (with poor or no vascularity) and type IIb (with rich vascularity). Three treatment methods were applied in each group. Of included cases, there were 53 CSP and 12 CP. There was no significant difference between Type I and Type II groups in any variable. The beta human chorionic gonadotropin (β-hCG) level and gestational age of type IIb were significantly higher compared to type IIa (p < 0.05). There was a positive correlation between ultrasound categories and treatment methods (rs = 0.723, p = 0.000). Analysis of CSP cases of initial treatment failure indicated success rate of initial dilation and curettage (D&C) was dependent upon ultrasonic types, mean sac diameter, gestational age, hCG level, and number of cesarean sections. The features of ultrasound imaging might provide an additional reference for the selection of clinical treatment methods.

Serum β-human chorionic gonadotropin profile and its correlations with ultrasound parameters in low-lying-implantation ectopic pregnancy in the first trimester.

Cervical pregnancy (CP) and cesarean scar pregnancy (CSP), defined as low-lying-implantation ectopic pregnancy (LLIEP), are rare conditions of aberrant implantation around the lowest portion of the uterus. This study aimed to illustrate the serum β-human chorionic gonadotropin (β-hCG) profile of LLIEP and to explore its implications with the clinical characteristics. Women with LLIEP during the first trimester were retrospectively evaluated at a tertiary referral center from August 1999 to July 2016. Demographic and clinical data were recorded, including maternal age, gestational age (GA), serum β-hCG level, maximal diameter of the gestational mass/sac (MDM/MDS) by ultrasonography and CSP implantation types. The serum β-hCG level was measured on the day of ultrasound imaging. The significance of pretreatment the serum β-hCG level and its correlations with the clinical characteristics were analyzed. A total of 88 LLIEP with 64 CSP and 24 CP was included. The mean GA at the time of diagnosis was 7 weeks (range, 5-12 weeks). The β-hCG concentrations rapidly increased from GA 5 to 9 weeks and fluctuated thereafter. The β-hCG levels correlated positively with GA and ultrasound MDM/MDS. In the CSP group, there was no difference in the β-hCG level between superficial and deep implantation types. β-hCG levels demonstrated no significant differences among simple and complicated LLIEP. This study established the serum β-hCG profile in LLIEP in the first trimester. The exponential increase of β-hCG levels was similar to that of normal intrauterine pregnancies. The β-hCG levels were not associated with placentation complexity of CSP. Higher β-hCG levels did not implicate less success in conservative surgical management.