Diagnosis Of Cervical Pregnancy Research Articles

ЭФФЕКТИВНОСТЬ ОРГАНОСОХРАНЯЮЩЕЙ ТАКТИКИ ВЕДЕНИЯ ПРИ ШЕЕЧНОЙ БЕРЕМЕННОСТИ

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

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.

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

Įvadas Nėštumas gimdos kaklelyje yra reta patologija, kurios tiksli etiologija nežinoma. Ši būklė gali būti gyvybiškai pavojinga ir gydoma totalia laparotomine histerektomija, tačiau tobulėjanti diagnostika leidžia ektopinį nėštumą gimdos kaklelyje gydyti išsaugant vaisingumą. Klinikinis atvejis 38 metų pacientė buvo paguldyta į Klaipėdos Jūrininkų ligoninę dėl kraujavimo iš makšties ir skausmo apatinėje pilvo dalyje. Nuodugniai ištyrus pacientę, buvo diagnozuotas nėštumas gimdos kaklelyje. Apsvarsčius skirtingas gydymo taktikas, totali laparotominė histerektomija buvo pasirinka kaip tinkamiausias gydymo būdas. Operacija buvo sėkminga, pooperacinis lai­kotarpis sklandus. Diskusija Ultragarso tyrimas yra pagrindinis nėštumo gimdos kaklelyje diagnostikos metodas. Skėtikliais ir bimanualinio tyrimo metu dažniausiai randami svarbūs pakitimai, kurie padeda pagrįsti diagnozę. Totali laparotominė histerektomija buvo pagrindinis gydymo metodas, tačiau tobulėjant diagnostikos metodams metotreksatas tapo pirmos eilės pasirinkimu kaklelinio nėštumo atveju. Kiti konservatyvūs gydymo metodai, pavyzdžiui, gimdos ir gimdos kaklelio abrazija, lydima tamponavimo Foley kate­teriu, ar gimdos arterijos embolizacija, tampa vis populiaresni. Išvados Duomenys apie kaklelinį nėštumą yra riboti dėl šios patologijos retumo ir kiekvienas atvejis turi būti vertinamas individualiai. Noras išsaugoti vaisingumą ir pacientės būklė yra pagrindiniai rodikliai, į kuriuos būtina atsižvelgti nusprendžiant, kokią gy­dymo taktiką pasirinkti esant nėštumui gimdos kaklelyje.

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases.

The purpose of this retrospective study was to evaluate the safety and efficacy of uterine artery embolization (UAE) followed by curettage for conservative management of cervical pregnancy. Retrospective review. Peking University First Hospital. Patients with cervical pregnancy diagnosed by trans-vaginal ultrasound at Peking University First Hospital between January 2003 and December 2014. We retrospectively reviewed the clinical background and outcomes of patients with cervical pregnancy who underwent UAE followed by curettage for prevention of massive vaginal bleeding and removal of gestational tissue from the cervix. We also reviewed the literature on the role of UAE in the treatment of cervical pregnancy. Clinical assessments included gestational age, gravidity, endocervical canal mass, serum beta-human chorionic gonadotrophin (β-HCG) level, blood loss, hospitalisation stay and expenses, time of resumption of menstruation and subsequent pregnancy outcomes. A total of 19 patients with cervical pregnancy treated with UAE followed by curettage were identified. Curettage was performed 24-72hours after UAE in 16 patients, within 24hours after UAE in three patients. None of the patients underwent a hysterectomy as a result of cervical pregnancy. Of the nine patients with available follow-up information (median follow-up time 59months), eight resumed normal menstruation and one had a term pregnancy with a normal vaginal delivery. Quick regression of serum β-HCG level, low blood loss and short hospital stay were observed. UAE combined with curettage is a safe, effective and fertility-sparing choice for treatment of patients with cervical pregnancy. A serial of 19 patients with cervical pregnancy treated with UAE followed by curettage showed a good prognosis.

Cervical ectopic pregnacy mimicking missed abortion

Cervical pregnancy is a rare variety of Ectopic pregnancy. It is a life threatening form of ectopic pregnancy. The diagnosis of cervical pregnancy can be missed by an unsuspecting mind inspite of the routine use of first trimester Ultrasonography. Careful evaluation is necessary for immediate proper management of such case.DOI: http://dx.doi.org/10.3329/bmjk.v44i1-2.10474Bang Med J (Khulna) 2011: 44(1&amp;2) 28-30

OC05.02: Surgical treatment of first trimester cervical ectopic pregnancies

Objectives: To assess the efficacy and safety of surgical evacuation in the management of cervical ectopic pregnancies. Methods: Women with a certain ultrasound diagnosis of cervical pregnancy were offered surgical evacuation under general anaesthetic. Procedures were performed under ultrasound guidance using suction curette. Shirodkar cervical suture was used selectively to secure haemostasis following evacuation of pregnancy. Intravenous ergometrine 500 μg was administered intra-operatively to ensure uterine contraction. The patients were prescribed prophylactic antibiotics and the suture was removed 48–72 hours later in the outpatient clinic. Results: Over a 10 year period 40 women were diagnosed with cervical pregnancy in our Units. Of the 40 cases, 39 (98%, 95% CI 87–100) women presented 12 weeks’ gestation with a viable fetus. 26/39 (67%, 95% CI 51–79) women underwent surgical evacuation, whilst the remaining 13/39 (33%, 95% CI 21–49) women were managed conservatively. The median intra-operative blood loss was 250mls (range, 50–2000). 10/26 (38%, 95% CI 22–57) women had Shirodkar cervical suture inserted to arrest intra-operative haemorrhage. 2/26 (8%, 95% CI 2–24) women required blood transfusion. The uterus was successfully preserved in all women. Two (8%, 95% CI 2–23) women required repeat surgical evacuation; one woman had retained products of conception and the other had persistent haematometra. There were no cases of pelvic infection or any other postoperative complications. Conclusions: Surgical evacuation is a safe and effective method in the management of first trimester cervical ectopic pregnancy. The use of Shirodkar suture minimises the need of blood transfusion and the risk of hysterectomy is very low.

Cervical Ectopic Pregnancy: Case Reports and Management Modalities

ABSTRACT Cervical pregnancy is a rare variety of ectopic pregnancy. The diagnosis of cervical pregnancy can be missed by an unsuspecting mind inspite of the routine use of first trimester ultrasonography. We present two cases of cervical pregnancy managed at our hospital alongwith a brief review of literature highlighting the various treatment modalities.

Exocervical Pregnancy in a Patient with Intrauterine Device: A Case Report

Cervical pregnancy (CP) is a rare and life-threatening ectopic pregnancy characterized by implantation of the fertilized ovum into the cervix, whereas exocervical pregnancy is an extremely rare CP with implantation of the fertilized ovum on the exocervix. Possible causative factors of CP such as tubal dysfunction, impaired sperm motility, previous uterine surgery, or the use of intrauterine device were not clearly associated with the development of CP until now. Diagnosis of CP is usually established by ultrasonography and by β-human chorionic gonadotropin serum tests, but definitive diagnosis is by histologic examination. Current treatment strategies of CP, which were described in some reports, involve: medical treatment with methotrexate, surgical removal of ectopic trophoblastic tissues, cervical cerclage and vaginal packing, ligation of descending branches of uterine arteries or hypogastric arteries, and unilateral internal iliac artery embolization. We report a case of exocervical pregnancy contemporary to intrauterine device normally inserted, diagnosed by colposcopy, β-human chorionic gonadotropin, and histology, and treated by a local excision without using methotrexate chemotherapy.

Three-Dimensional Power Doppler Ultrasound Diagnosis and Laparoscopic Management of a Pregancy in a Previous Cesarean Scar

An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

Three-Dimensional Power Doppler Ultrasound Diagnosis and Laparoscopic Management of a Pregancy in a Previous Cesarean Scar

An ectopic pregnancy developing in a previous Cesarean section scar is a rare event, and there is still a lack of information concerning the adequacy of management strategies. So far, no modality can guarantee the integrity of the uterus. We report the case of a 29-year-old woman with three Cesarean deliveries who was transferred to our hospital with a diagnosis of cervical pregnancy. Transvaginal three-dimensional power Doppler ultrasound revealed a well-encapsulated bulging mass displacing anteriorly over the lower anterior uterine wall sounding with an irregular course and branching vessels. The diagnosis of pregnancy in a previous Cesarean scar was made. Laparoscopic ligation of bilateral uterine arteries followed by excision of the ectopic pregnant mass was undertaken, and the patient's uterus was successfully preserved. Conservative management with the laparoscopic approach may be a safe and effective alternative to hysterectomy in patients with a pregnacy in a previous Cesarean scar.

Differential diagnosis of suspected cervical pregnancy and conservative treatment with the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection

Objective To determine the accuracy of differential diagnosis by team consultation of abortion in progression, low-lying implantation/cervicoisthmic pregnancy, and cervical pregnancy (CP) in patients referred for suspicion of abnormal implantation on the lower segment and cervix of the uterus and to determine the efficacy of endoscopic surgery with uterine artery blockade followed by cervical evacuation in the treatment of confirmed CP. Design Prospective observational study under multiple-clinic and multiple-hospital cooperation. Setting Tertiary clinical and academic medical center. Patient(s) Twenty-seven women with a tentative diagnosis of CP made at their primary gynecologists' offices from July 1999 to June 2003. Intervention(s) Second-opinion ultrasound scanning with transabdominal and transvaginal approach and optional color Doppler use. For patients with confirmed CP, a new treatment modality with laparoscopy-assisted uterine artery ligation followed by hysteroscopic local endocervical resection to remove the ectopic pregnancy was employed. For patients with abortion in progression or low-lying implantation/cervicoisthmic pregnancy (non-CP) requiring termination, dilatation and curettage (D&C) was performed under transabdominal ultrasound guidance. Main outcome measure(s) Fulfillment of ultrasound-based diagnostic criteria and operative course, convalescence, and commencement of menstruation in those patients with confirmed CP. Result(s) Cervical pregnancy was diagnosed in six (22.2%) patients at ≤9-weeks' gestation, and they were all successfully treated without the need for adjuvant therapy. The mean operating time was 119 minutes, and the mean blood loss was 125 mL. Menstruation began a mean of 63 days after the treatment. Termination of non-CPs was achieved by a simple D&C. Conclusion(s) Team consultation minimizes false-positive ultrasound-based diagnosis of CP. A single-step combination endoscopic operation is an effective uterus-preserving alternative in the management of CP.

“Hour‐glass” shape of the uterus in the diagnosis and treatment of cervical pregnancy

This study attempts to point out the importance of the anatomo-clinical finding of an "hour-glass" shape to the uterus in the diagnosis and treatment of cervical pregnancy. From 1973 to 2001, four cases of cervical pregnancy were treated in the 2nd Obstetrical and Gynecological Clinic of the Aristotelion University of Salonica. The incidence was 1:13,111 pregnancies (4 cervical in 52,446 pregnancies). Three of the patients underwent bilateral ligation of the anterior trunk of the internal iliac artery using absorbable ligatures. The fourth patient (a 42-year-old), elected to have a hysterectomy. All patients were well and discharged from hospital on the seventh postoperative day. Two of the three patients treated by ligation of the anterior trunk of the internal iliac arteries subsequently had normal pregnancies and deliveries. We lost contact with the third patient. The finding of an "hour-glass" uterine shape was very helpful in the diagnosis of cervical pregnancy. The Aristotelion University of Salonica has found that treatment by ligation of the anterior trunk of the internal iliac arteries is effective, causes no complications, never ends in hysterectomy, and maintains the normal menstrual cycles and reproductive ability of the woman.

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin

Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin.

(2004). Cervical pregnancy after in vitro fertilization and embryo transfer successfully treated with methotrexate and intracervical injection of vasopressin. Acta Obstetricia et Gynecologica Scandinavica: Vol. 83, No. 1, pp. 112-114.

Uterine artery embolization in a 10-week cervical pregnancy with coexisting fibroids

A 36-year-old woman, gravid 3, para 1, abortus 1, was admitted to our department at 10 weeks and 4 days of gestation with the diagnosis of cervical pregnancy and multiple uterine fibroids. After admission she underwent angiographic embolization of bilateral uterine arteries followed by intraamniotic 70-mg methotrexate injection. Despite being given a second dose of methotrexate injection 1 week later, the gestational sac did not resolve spontaneously, thus vacuum evacuation and curettage of the cervical canal was required on the 15th day of embolization. The patient was discharged in good condition. She had no complaints by post-operative at month 11, except amenorrhea. Her uterine fibroids markedly decreased in size after the procedure. As a result, embolization of uterine arteries provided surgical evacuation of cervical pregnancy with minimal hemorrhage, and the patient's potential fertility was preserved, but a long-term amenorrhea was observed.

Cervical pregnancy: past and future.

Cervical pregnancy (CP) is a rare life-threatening form of ectopic pregnancy occurring in 1 of 8628 deliveries. We reviewed 117 cases of CP in the English language literature from 1978 and added three cases from our department. Etiology of CP is still unknown, but there is evidence for its association with cervicouterine instrumentation. The possible role of embryo chromosomal abnormality in the CP etiology is considered. Sonography improved pretreatment diagnosis up to 81.8 percent. Obligatory sonographic criteria of CP include endocervical localization of the gestational sac and trophoblastic invasion. About 60 percent of cervical pregnancies are with a viable fetus. The majority of patients with a cervical pregnancy are women with low parity, thus, the current treatment trend is to preserve their reproductive function. The main problem of conservative treatment is life-threatening hemorrhage after pregnancy evacuation. The use of cervical canal tamponade with a Foley catheter balloon led to reliable hemostasis in 92.3 percent of cases in which this method was used. Early diagnosis of CP allowed for treatment by chemotherapy in 32 cases, with an 81.3 percent success rate. Serial beta-human chorionic gonadotropin levels and transvaginal ultrasound with color Doppler are used to monitor therapy. Another conservative treatment modality is local intrasac KCI injections. Hysterectomy is recommended mostly for second and third trimester cervical pregnancy, or for uncontrolled bleeding.

Use of ultrasound and magnetic resonance imaging in the diagnosis of cervical pregnancy

Use of ultrasound and magnetic resonance imaging in the diagnosis of cervical pregnancy

To the diagnosis of cervical pregnancy

The study of materials from gynecological hospitals in Omsk over the past two decades has allowed us to establish that out of 13 women with cervical pregnancy who underwent subsequent surgical treatment, the primary diagnosis was reliable only in 4. In the rest, cervical pregnancy was mistaken for a normal uterine pregnancy (in 5), for an incomplete abortion (in 3), for a hematocervix (in 1).