Management Of Cervical Ectopic Pregnancy Research Articles

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

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

Successful management of cervical ectopic pregnancy following invitro fertilisation

We report a case of a 45-year-old woman with successful management of cervical ectopic pregnancy using ultrasound guided suction evacuation and balloon tamponade. The case report owes its significance to the high morbidity and mortality associated with this form of ectopic pregnancy in our environment, because of misdiagnosis and late presentation.

Management of Cervical Ectopic Pregnancies: A Scoping Review

(Abstracted from Obstet Gynecol 2021;138(1):33–41) Cervical ectopic pregnancies represent fewer than 0.1% of all ectopic pregnancies but carry increased risk of significant hemorrhage and long-term reproductive consequences if not managed properly. In part due to the rarity of their occurrence, a standard-of-care protocol for management of cervical ectopic pregnancy (EP) other than hysterectomy does not exist.

Fertility-preserving Management of Cervical Ectopic Pregnancy in a Nigerian Teaching Hospital

Cervical Ectopic Pregnancies (CEPs) are commonly associated with adverse outcomes due to diagnostic and treatment challenges. This report describes the successful management of an initially misdiagnosed CEP. A 30-year-old G4P2+1(Alive 2) presented to the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, with vaginal bleeding following 11 weeks amenorrhea. The patient was haemodynamically stable, with minimal bleeding per vaginam, and ultrasonography had previously diagnosed complete miscarriage. However, transvaginal ultrasonography demonstrated classical hour-glass uterus. The ballooned cervix contained a gestational sac and foetal node without cardiac activity. The patient was managed with a single dose of intramuscular methotrexate injection. Her serum B-HCG concentration declined from 460.8mIU/ml at presentation to <5mIU/ml on the 10th day post-methotrexate injection, with a complete clinical and ultrasonographic resolution of the features. A high index of suspicion and appropriate ultrasonographic skills are necessary for prompt diagnosis of a CEP. Medical management could minimise the risk of intractable haemorrhage and hysterectomy.

Cervical ectopic pregnancy

We performed dilation and curettage and cervical balloon placement in a cervical ectopic pregnancy after treatment with Methotrexate, KCI and bilateral uterine artery embolization. A minimally invasive approach was used in the case as the patient desired future fertility. We present the potential challenges in management of cervical ectopic pregnancy as well as approaches to treatment.

Management of Cervical Ectopic Pregnancies: A Scoping Review.

To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics. PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy. A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy. Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.

Effective combined treatment in ectopic cervical pregnancy preserving fertility: a case report and literature review.

Cervical ectopic pregnancy (CEP) is a rare obstetric complication but carries the risk of life-threatening maternal hemorrhage. A 43-year-old nulliparous woman, presented to the Emergency Room with vaginal bleeding. Initial quantitative serum β-hCG value was 85,220 mIU/mL. Obstetrical ultrasound demonstrated a single, live pregnancy of approximately 9 weeks' gestation located within the endocervix. After discussing different management options, intramuscular methotrexate injection in association with intra-amniotic chloride potassium installation was decided in order to preserve patient's desire for childbearing. Three months later, the patient was readmitted due to a massive vaginal bleeding. Angiographic uterine artery embolization (UAE) with an absorbable gelatin sponge was performed. After the procedure and two days of hospitalization, no significative bleeding was observed. The clinical course was uneventful, and serum human chorionic gonadotropin decreased immediately. The cervical mass gradually shrank and disappeared a month after UAE. To preserve fertility in the management of CEP, clinicians could consider a combination of strategies, including UAE. A review of the current literature and possible treatment options for conservative CEP management are analyzed and discussed.

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.

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.

Laparoscopic Management of Cervical Ectopic Pregnancy with Devascularization

Laparoscopic Management of Cervical Ectopic Pregnancy with Devascularization

Management of Cervical Ectopic Pregnancies: A Systematic Review [9Q

INTRODUCTION: Cervical pregnancies are 0.01% of ectopic pregnancies and pose a considerable risk of hemorrhage. There is currently no consensus on management. This is a systematic review of published cases in the last decade. METHODS: PubMed and other databases were searched on July 2, 2017 using variations of the terms “cervical ectopic pregnancy” and “cervical pregnancy” for peer-reviewed citations published in English, Spanish, or French between 2007 and 2017. RESULTS: One-hundred-and-eleven articles representing 209 patients were included. Initial interventions included expectant management (3); vaginal removal of lesion (2); uterine artery embolization (UAE) (1); UAE and curettage (34); curettage (42); UAE and methotrexate (22); methotrexate alone (79); hysteroscopic resection (12), UAE and laparoscopy (5), and hysterectomy (6). Sixty patients failed initial intervention, including 38 who received methotrexate alone (58%), 5 who underwent methotrexate with UAE (26%), and 10 who underwent curettage (23%). Thirty-seven patients experienced hemorrhage, including 21% who initially received methotrexate; 40% who initially underwent curettage; and 12% of those initially managed with curettage and UAE. These patients were managed with hysterectomy (6); cerclage (4); curettage (7); UAE (7), and UAE and curettage (3). Overall patients did well with conservative management. CONCLUSION: For stable cervical ectopic patients, conservative management with methotrexate (including intraamniotic feticide if fetal cardiac activity is present) may be considered. Importantly, uterine artery embolization is worth considering prior to either surgical or medical management, and is recommended in any unstable patient.

265 - Laparoscopic and Hysteroscopic Management of a Cervical Ectopic Pregnancy

Introduction: Cervical ectopic pregnancy is a rare but serious condition. Management of cervical ectopic pregnancy varies by institution depending on surgical expertise and availability of interventional radiology.

Conservative management of cervical ectopic pregnancy: Single-center experience.

The aim of this study was to assess the results of conservative treatment of cervical ectopic pregnancy (CEP). We retrospectively reviewed all cervical ectopic pregnancies diagnosed at the present department between January 2010 and July 2015. Patients with CEP who were treated with either systemic or intra-amniotic methotrexate (MTX) injection were included in the study. Ten CEP patients were identified. Median maternal age was 33 years (range, 23-40 years). Median gestational age at diagnosis was 47days (range, 44-58days). Before treatment, overall mean serum beta-human chorionic gonadotrophin (β-hCG) was 29 706.9±19 695.2 mIU/mL. Mean gestational sac size was 29.0±6.24mm. Eight patients had viable fetuses with detected cardiac activity. Six patients were treated primarily with systemic MTX, and four were treated with local MTX injection. One patient in the systemic MTX injection group was switched to local MTX treatment due to severe oral ulceration and increasing β-hCG titers after the fourth dose. One patient in the local treatment group had severe hemorrhage 7days after local MTX. Three of six women achieved spontaneous pregnancy and gave birth to term, healthy infants after treatment. Conservative treatment of CEP with both systemic and local MTX is generally successful with regard to maternal morbidity and reproductive function, but these patients must be closely followed due to the small but real risk of late hemorrhage.

Medical Management of Cervical Ectopic Pregnancy

Medical Management of Cervical Ectopic Pregnancy

Successful Conservative Management of a Case of Cervical Ectopic Pregnancy complicated with Preexisting Cardiomyopathy

ABSTRACT Background Cervical ectopic pregnancies account for less than 1% of all pregnancies. It may present with abnormal and occasionally heavy bleeding. Aim To understand the challenges associated with management of cervical ectopic pregnancies and learn to individualize the available treatment modalities for a successful outcome. Case report A 42-year-old woman, G6P2L2MTP3 with amenorrhea of 2 months, was diagnosed with cervical ectopic pregnancy of 9 weeks on ultrasonography. She was a known case of dilated cardiomyopathy with type II diastolic dysfunction and an ejection fraction of 25%. The patient was given systemic methotrexate followed by intra-amniotic methotrexate and fetal intracardiac potassium chloride. She was followed up with serial β-human chorionic gonadotropin (hCG) reports. However, she developed abdominal pain with bleeding per vaginum and ultrasonography suggestive of a hematoma. The patient was then taken up for a bilateral uterine artery embolization followed by an immediate suction evacuation. The products of conception sent for histopathology confirmed the microscopic diagnosis of cervical pregnancy. Conclusion It is a challenging clinical situation to diagnose and manage. It needs to be diagnosed early, and management needs to be individualized. Clinical significance Even with advanced diagnostic modalities and reduction in current mortality rates, cervical pregnancy remains a life-threatening condition. It is of utmost importance to be thorough with the emerging trends in its management, as it comes with the promise of being unpredictably catastrophic. How to cite this article Raza N, PaiDhungat NP. Successful Conservative Management of a Case of Cervical Ectopic Pregnancy complicated with Preexisting Cardiomyopathy. J South Asian Feder Obst Gynae 2017;9(4):356-359.

Medical Management of Cervical Ectopic Pregnancy

Cervical ectopic pregnancy is a rare condition with implantation in the endocervical canal below the closed internal os. It accounts for less than 1% of all ectopic pregnancies. It is associated with high morbidity and mortality. A case of cervical ectopic pregnancy is reported. She was a young nulliparous female, timely referred from peripheral hospital. She was treated successfully with medical management and thus fertility was preserved

Conservative Management of Cervical Ectopic Pregnancy.

To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies. We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians. Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade. Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.

Successful Management of Live Cervical Ectopic Pregnancy: A Case Report

Cervical pregnancy is a rare form of ectopic pregnancy with potential grave consequences occurring in approximately 1:9,000 deliveries. It is life-threatening as the pregnancy is implanted in the endocervical canal and the trophoblast can penetrate through the cervical wall and into the uterine blood supply resulting in catastrophic haemorrhage. Historically, the treatment had been hysterectomy because of the considerable risk of life-threatening haemorrhage, but in the recent past various conservative management modalities have been applied to preserve fertility. Here, we report a case of successful (both medical and surgical) management of cervical ectopic pregnancy in a young woman. A 29-year-old, gravid 2, para1 and living 1 with previous caesarean section had presented with mild bleeding per vagina for 5 days following 7 weeks of amenorrhoea. Past menstrual, medical, surgical and family history were unremarkable except the previous caesarean section. On examination vital signs were normal but pelvic examination revealed a distended cervix with bulky uterus, without anyadnexal mass or tenderness and no cervical motion tenderness. Further transvaginal sonography showed a live cervical gestation of 7 weeks and 4 days and serum beta-HCG value of 1,03,113mIU/ml. Patient received conservative approach with combination of intraamniotic potassium chloride and methotrexate and suction curettage. Due to conservative approach emergency hysterectomy and blood transfusion was avoided.

Conservative management of cervical ectopic pregnancy: systemic methotrexate followed by curettage

Cervical ectopic pregnancy is among the rarest clinical conditions happening in women of reproductive age. Yet its management can cause a high rate of morbidity. Therefore, conservative treatment of this condition is a matter of debate. Hereby we present two cases of cervical ectopic pregnancies that were managed successfully with a conservative approach. Cervical ectopic pregnancy can be managed successfully with systemic Metotroxsate followed by curettage.