Management Of Cervical Ectopic Pregnancy Research Articles

Diagnosis and management of cervical ectopic pregnancy

Cervical ectopic pregnancy (CP) is a rare condition with an incidence of less than 0.1% of all ectopic pregnancies. It is associated with a high morbidity and mortality potential. Timely intervention is required to preserve fertility and avoid the need for a hysterectomy. A case of CP is reported and the challenges in the diagnosis and management are discussed.

Conservative management of a 20-week cervical ectopic pregnancy with placenta percreta

Cervical pregnancy is a rare form of ectopic pregnancy representing less than 1 % of all ectopic pregnancies. The implantation occurs in the cervical stroma below the level of the internal os. Failure to diagnose early, with continued progression of cervical ectopic pregnancy is associated with unpredictable occurrence of uncontrollable hemorrhage [1]. Early diagnosis is essential as it allows treatment with minimal intervention and reduction in overall morbidity and mortality. Different approaches have been described for conservative management of cervical ectopic pregnancy aimed at preserving future fertility. These include systemic or local methotrexate injection with intra-amniotic needle aspiration of fluid, local potassium chloride injection, dilatation and curettage, amputation of the cervix or partial trachelectomy [2]. Interventions employed in conservative management to decrease hemorrhage are intra-cervical tamponade with a Foley catheter, angiographic uterine artery occlusion, internal iliac artery ligation and cervical cerclage. However, there is still the potential for conservative management to fail and result in severe hemorrhage warranting surgical management such as definitive hysterectomy. Due to the rarity of cervical ectopic pregnancies and advanced cervical ectopic pregnancies historically being managed surgically, there is a lack of information in the literature on conservative management of advanced cervical ectopic pregnancies. At our institution, we successfully managed conservatively a second trimester cervical ectopic pregnancy at 15 weeks gestation [3]. We describe in this case report our experience on conservative management of a cervical ectopic pregnancy at 20 weeks gestation. To the best of our knowledge, this is the first case of a 20-week cervical ectopic pregnancy successfully managed conservatively followed by a subsequent live term uncomplicated delivery.

Conservative management of cervical ectopic pregnancy: utility of uterine artery embolization

To evaluate the use of uterine artery embolization (UAE) in conjunction with methotrexate in the conservative treatment of cervical ectopic pregnancy (CEP). Case series. Tertiary-care university hospital. Cases of CEP treated at Hutzel Women's Hospital between January 1997 and December 2008. Multidose methotrexate treatment with or without UAE and intra-amniotic potassium chloride injection (KCl). Beta-human chorionic gonadotropin level, vaginal bleeding, length of hospital stay, and future fecundity. A retrospective analysis of 15 patients with CEP treated conservatively using methotrexate with leucovorin rescue (MTx/Leu) alone (group 1, five cases), with UAE as an adjunctive therapy (group 2, six cases), or also having received intra-amniotic KCl before UAE (group 3, four cases) is reported. There was no significant difference in age, parity, or gestational age among treatment groups. The median β-hCG level on presentation was 9,606 mIU/mL for group 1, 26,516 mIU/mL for group 2, and 130,464 mIU/mL for group 3. The difference was found to be statistically significant. No patients developed complications from UAE. Of the 10 patients who underwent UAE, 2 subsequently had confirmed viable pregnancies. Uterine artery embolization with methotrexate is an option for minimally invasive intervention in the treatment of CEP.

Therapeutic management of cervical ectopic pregnancy

Ectopic pregnancy is one of the most important risk factors for maternal morbidity and mortality in early pregnancy. Cervical ectopic pregnancy is the rarest localization of ectopic pregnancy, although it constitutes a high-risk situation. On the one hand, there is a high rate of incorrect diagnosis; on the other, the clinician might be faced with severe therapeutic complications – for example, life-threatening hemorrhage. There are a variety of therapeutic alternatives but no standard guidelines exist regarding the ideal treatment. In most cases, successful treatment is achieved by a combination of therapeutic options. Conservation of fertility has priority, while massive hemorrhage also needs to be prevented. In this article, we present pitfalls and current strategies for diagnosis and management in patients with cervical pregnancy by introducing a classical constellation in an affected patient.

Conservative Management of Cervical Ectopic Pregnancy. A Case Report and Evidence-Based Approach

Conservative Management of Cervical Ectopic Pregnancy. A Case Report and Evidence-Based Approach

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.

Successful conservative management of cervical ectopic pregnancy: a case series

To report our experience of conservative treatment in four patients with cervical ectopic pregnancy. Case series. Academic medical center. Four women diagnosed with cervical ectopic pregnancy managed conservatively. Systemic methotrexate alone or combined with subsequent uterine artery embolization (UAE). Conservative management with decreased rate of serious complications. No hysterectomies were needed. One patient required subsequent intervention, UAE. Conservative treatment of cervical pregnancy might be successful with careful follow up and subsequent conservative interventions.

Partial Trachelectomy: A New and Final Option for Fertility-Preserving Management of Cervical Ectopic Pregnancy

Background: Although the application of methotrexate (MTX) and the development of interventional radiology has made uterine preservation possible for cervical ectopic pregnancy in most cases, hysterectomy is typically performed as the final measure to treat patients when conservative therapy has failed. By contrast, radical trachelectomy is often selected for early invasive cervical cancer to maintain the fertility of the patients. The aim of this study was to develop a fertility-sparing surgical procedure for cervical ectopic pregnancy. Case: A 26-year-old nulliparous woman suffered cervical ectopic pregnancy with a gestational age of about 8 weeks, and curettage caused uncontrollable hemorrhage after 6 courses of MTX treatment reduced the serum beta human chorionic gonadotropin level from 187,497 to 4 IU/mL. Then, the surgery “partial trachelectomy,” including (1) interruption of blood supply by ligating the bilateral descending branches of the uterine artery, (2) circumcision of the vaginal fornix and partial resection of cervical wall with the ectopic product of conception, and (3) reconstruction of the cervix and anastomosis between the vagina and cervix, was attempted to spare potential fertility, and the efficacy of this procedure was evaluated by observing the postoperative course. Results: Menstruation returned after 1 month and magnetic resonance imaging at 6 months postsurgery showed a normal corpus and small cervix. Conclusions: This potential fertility-preserving surgical technique should be applied when it is considered difficult to treat by using ordinary conservative therapy, including MTX administration, or when hysterectomy is indicated to save the life of a mother who still hopes to preserve her uterus. (J GYNECOL SURG 25:139)

Conservative Management of Cervical Ectopic Pregnancy: The Utility of Uterine Artery Embolization

Conservative Management of Cervical Ectopic Pregnancy: The Utility of Uterine Artery Embolization

P950 Conservative management of cervical ectopic pregnancy

P950 Conservative management of cervical ectopic pregnancy

Conservative management of cervical ectopic pregnancy

To evaluate the safety and efficacy of a minimally invasive approach in the management of cervical ectopic pregnancies. Retrospective case series. University tertiary care hospital. Twenty-four women diagnosed with cervical ectopic pregnancy managed conservatively. Systemic methotrexate alone or combined with ultrasound-guided fetal intracardiac injection of potassium chloride. Reduction in hysterectomy rate, incidence of serious complications, and necessity for further intervention. Conservative management of cervical ectopic pregnancy was successful in preventing the need for hysterectomy in all patients in our study. In two patients with a heterotopic gestation the intrauterine pregnancy could successfully be salvaged. Four patients experienced morbidity that required additional interventions. Most cervical ectopic pregnancies can be safely managed in a minimally invasive manner.

Combined Medical – Surgical Management of Cervical Ectopic Pregnancy – A Case Report

Cervical pregnancy accounts for less than 1% of extrauterine gestations but is one of the most serious ectopic pregnancies associated with significant morbidity due to the potential of extensive haemorrhage, perforation of cervical canal, and devastating effects on future fertility. There are different medical and surgical management options for cervical ectopic pregnancy. In our case, we chose to give the patient a single dose of systemic intramuscular methotrexate+oral mifepristone with explanation of risks and benefits of chosen methods and discussion of alternate methods. She had successful evacuation of cervical pregnancy without much blood loss, followed by hysteroscopy. We believe that there are not many cases reported of cervical ectopic pregnancy in UK and the management of cervical pregnancy is still a great challenge for the physicians. In this case, the unique feature was that we chose a stepwise successful combined medical and surgical approach to treat this ectopic pregnancy.

P29.07: Early diagnosis and conservative management of cervical ectopic pregnancy

P29.07: Early diagnosis and conservative management of cervical ectopic pregnancy

Tratamento de gestação cervical viável com aplicação intra-amniótica de metotrexato: relato de um caso

Gestação cervical é uma condição rara, em que ocorre implantação do ovo no canal cervical distendendo-o à medida que cresce. Corresponde a menos de 1% de todas as gestações ectópicas. A hemorragia indolor é sua característica clínica habitual e ao exame físico visualiza-se um colo hipertrófico e vascularizado, com tecido saindo pelo orifício externo do colo. Ultra-sonografia pode ser usada para complementar o diagnóstico, mostrando a presença do saco gestacional. Relatamos um caso de tratamento bem sucedido de gestação cervical viável de sete semanas. Morte fetal foi conseguida com uma injeção intra-amniótica única de metotrexato (25 mg) guiada por ultra-sonografia transvaginal. Metotrexato sistêmico em dose única intramuscular (50 mg/m²) foi associado. O tratamento conservador da gestação cervical com metotrexato foi efetivo e seguro.

The conservative management of cervical ectopic pregnancies

To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies. This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride. Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature. The conservative management of cervical ectopic pregnancy is effective and safe.

Conservative management of cervical ectopic pregnancy.

The increasing incidence of cervical pregnancies may be attributed to increased use of artificial reproductive techniques and diagnostic improvements. Historically surgery has been the mainstay of treatment, usually with a poor prognosis. Recently there has been a trend toward conservative management with improved prognosis. Spontaneous abortion of a cervical pregnancy is usually associated with profuse haemorrhage or sepsis. A case undergoing spontaneous abortion without any life-threatening sequelae is presented. South African Journal of Obstetrics and Gynaecology Vol. 12(1) 2006: 44-45

P04.13: Conservative management of cervical ectopic pregnancy

P04.13: Conservative management of cervical ectopic pregnancy

OC058: Conservative management of cervical ectopic pregnancies

combined with antibiotics given i.v. or orally. Successful treatment we defined as a patient in good health after 3 months, without clinical symptoms or laboratory signs of infection. Unsuccessful treatment we defined as relapse of TOA in less than 3 months or patients that had surgery in the form of laparoscopy or laparatomy for abscess/organ removal in less than 3 months. Results: The immediate success rate according to our definition was 94% for the whole material. If however, we compare the period 1986 to 1990 (5 years) with 2000 to 2002 (3 years) we see an improved success rate from 88 % to 97 %. The rate of success was not influenced by age, parity, earlier PID, size of abscess or universus bilateral abscess. As for the longterm outcome, 8% have had a new episode of TOA, which in almost all cases have been successfully treated in the same way as the first. In patients operated on more than 3 months after successful treatment, no rest of abscess was found. 25% of patients under 40 years have become pregnant after treatment. Conclusion: This method of treating TOA is simple, cheap and safe. We have had no major complications. With respect to the immediate success and longterm outcome, we recommend this as the method of choice for treatment of TOA.

Ultrasound Evaluation and Clinical Management of Persistent Gestational Sac in a Cervical Ectopic Pregnancy

Early diagnosis with vaginal ultrasound is critical to the conservative management of cervical ectopic pregnancy. Ultrasound findings of a persistent gestational sac within the endocervical canal during medical treatments, when accompanied by a continued decline in HCG levels, does not necessarily signal a failure of the medical treatment.