Management Of Cervical Pregnancy Research Articles

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

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.

Comparison of high-intensity focused ultrasound ablation and uterine artery embolization in the management of cervical pregnancy.

BackgroundCervical pregnancy (CP) is an uncommon type of ectopic pregnancy with a rising risk to life. Currently, there is no universal protocol for the safe and effective management of CP. This study aimed to investigate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) vs. uterine artery embolization (UAE) in the management of CP to develop a standard for the treatment of CP.MethodsFrom January 2015 to October 2021, 36 patients with CP were diagnosed, treated, and followed up at the Department of Gynecology of Third Xiangya Hospital of Central South University. A total of 11 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, and 25 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Medical records and pregnancy outcomes were retrospectively analyzed.ResultsCompared to the UAE group, the HIFU group had a shorter interval time (1.5 ± 0.21 days vs. 2.6 ± 0.26 days), shorter duration of hospitalization (5.5 ± 0.31 days vs. 6.6 ± 0.21 days), shorter recovery time of menstruation (30.6 ± 7.09 days vs. 36.9 ± 5.54 days), fewer adverse reactions (0/11 vs. 9/25), and fewer postoperative complications (1/11 vs. 8/25). There were no significant differences in age, gravidity, parity, abortion, gestational age, cardiac pulsation, admission symptoms, hemoglobin level, largest diameter of the sac/mass, serum human chorionic gonadotropin (hCG) level at admission, hospitalization expenses, hospitalization days, blood loss during curettage, degree of hCG decline, residue after curettage, fertility requirement, and pregnancy outcomes.ConclusionBoth HIFU and UAE are safe and effective in the treatment of patients with CP. Compared to UAE, HIFU treatment for CP is a safer and more effective therapeutic schedule owing to the advantages of being more minimally invasive, shorter interval time, shorter hospitalization days and recovery time of menstruation, fewer adverse reactions, and fewer postoperative complications.

Cervical pregnancy management by lauromacrogol combined with intrauterine visualization system and vacuum aspiration: two case studies

Background: Timely and effective intervention can avoid the need for hysterectomy in cervical pregnancy. This study reported 2 cervical pregnancy cases treated with lauromacrogol combined with intrauterine visualization system and vacuum aspiration under direct vision and negative pressure suction. Cases: A 33-year-old (para 0-0-2-0) and 26-year-old females (para 1-0-1-1) were admitted to our hospital for amenorrhoea followed by vaginal bleeding, with previous history of laparoscopic salpingectomy for ectopic pregnancy, and cesarean section and hysteroscopic resection of retained placenta after induced abortion, respectively. Both patients were treated with lauromacrogol combined with intrauterine visualization system and vacuum aspiration along with Foley catheter compression. Both surgeries were completed in one go. The effect was significant, safe, feasible, with no massive vaginal bleeding or complications. The serum hCG decreased rapidly, and the length of hospital stay was short. Conclusions: This combined treatment method has a definitive effect, and the application can be promoted clinically.

Critical Appraisal OF Cervical Pregnancy Management

For a long time, it was rare to see a case of cervical pregnancy (CP) throughout the journey in the field of obstetrics. Recently, the circumstances showed dramatic changes and I think not uncommonly every one elsewhere in the field may face this problem to some extent and the CP term strikes his/her ears. This may be attributed to an actual increase in CP rate that go parallel to widespread application of Assisted Reproduction Techniques (ART) procedures all over the world on one hand and earlier diagnosis owing to liberal utilization and more familiarity with Transvaginal Sonography (TVS) on the other hand

Cervical pregnancy management: An updated stepwise approach and algorithm.

The aim of this short review was to present and categorizes most of updated successful interventions for cervical pregnancy (CP) management in a simple designed easily recognized diagram together with a proposed algorithm of these interventions beside author clinical experience. A comprehensive literature search was carried out in the following electronic databases, PubMed, Scopus, Embase, Google Scholar, Directory of Open Access Journals and Cochrane electronic databases. Keywords including cervical ectopic pregnancy, medical treatment, conservative management, successful interventions, uterine artery embolization and hysteroscopy were used to search these various databases. There are different successful CP management interventions reported in the literature varied from simple to complex regimens according to the patient situation, obstetrician experience and availability of health services. These approaches were categorized in a stepwise diagram and a proposed algorithm. Up till now, there is no consensus regarding the optimal CP management. To the best of knowledge, this review was unprecedented in organizing and categorizing the different successful CP management interventions. The proposed currently undertaken stepwise approach diagram and algorithm highlights the rapidly changing management of CP and open the door for further meta-analysis.

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.

Hysteroscopic management of cervical pregnancy: Case series and review of the literature

PurposeTo evaluate the hysteroscopic management on cervical pregnancy. Materials and methodsA case series report and literature review on patients with early first trimester cervical pregnancy (CP) treated by hysteroscopy. The symptoms upon admission, β-hCG levels, hysteroscopy technique, blood loss and operation outcomes were presented. ResultsFour patients with early CP between 5 and 7 weeks were successfully managed with operative hysteroscopy. Three out of four patients had at least one risk factor for cervical ectopic pregnancy. Two patients were diagnosed on routine examinations and the other two presented with vaginal spotting and pelvic pain. Mechanical hysteroscopy was used in three patients while one case was managed by a 10mm resectoscope. Three women discharged home on the same day and one patient 24h after the operation. Literature review revealed 16 publications of cervical pregnancy managed with operative hysteroscopy. 14 articles demonstrated single case reports and two papers were CP case series. Hysteroscopic surgery was successfully reported in 12 cases as a sole treatment, in seven cases after failure of methotrexate treatment and in eight cases as a combined treatment with uterine artery embolization. ConclusionsOur case series demonstrated that operative hysteroscopy can be used as a sole treatment in early, less than 8-week CPs with safety. Literature review demonstrated that most of the early first trimester CP cases were treated by hysteroscopy and the rest after failure of methotrexate treatment or in combination with uterine artery embolization.

メソトレキサート全身投与のみで治療し得た頸管妊娠の1例 頸管妊娠に対する治療法の選択―自験例と文献的考察―

メソトレキサート全身投与のみで治療し得た頸管妊娠の1例 頸管妊娠に対する治療法の選択―自験例と文献的考察―

Management of Cervical Pregnancy: Case Series and Literature Review

Cervical pregnancy is a rare form of ectopic pregnancy and clinical diagnosis is a challenge to physicians. At present, there is no consensus for standard treatment, but medical treatment becomes the first line treatment. We have reported four cases of cervical pregnancy and reviewed literatures regarding the diagnosis and modalities of treatment for this condition.

Management of Cervical Pregnancy with a Combination of Systemic Methotrexate and Ultrasound-Guided Local Instillation of Methotrexate and Potassium Chloride: A Case Report and Review of the Literature

Abstract Background: Cervical pregnancy is a rare and life-threatening obstetric condition. The management options are diverse and have changed over time, focusing on prevention of major hemorrhage along with preservation of fertility. Case: This article presents a case of a cervical ectopic pregnancy in a primigravida without any known risk factors at 5 4/7 weeks of gestation. The patient was given 75 mg of methotrexate (MTX) intramuscularly at 5 5/7 weeks of gestation. Her beta–human chorionic gonadotropin value rose 8% between day 4 and day 7. She was then managed with transvaginal ultrasound–guided local instillation of MTX and potassium chloride (KCL) at 6 4/7 weeks of gestation. Results: She responded well to the combination therapy and did not require any additional procedures. There are only 4 such cases reported in the literature so far, all of whom were treated similarly; the treatment was successful. A review of the literature suggests that this treatment is associated with a better response ra...

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.

Heterotopic Cervical Pregnancy

We report a rare case of heterotopic cervical pregnancy, which posed diagnostic challenge. With increasing IVF treatment and raising cesarean section rate, there is increasing incidence for non-tubal heterotopic pregnancy. We have discussed the clinical course of our case, diagnosis and management of cervical pregnancy and some good medical practices to avoid missing atypical presentations of ectopic pregnancy. J Clin Gynecol Obstet. 2015;4(4):307-311 doi: http://dx.doi.org/10.14740/jcgo369w

Minimal Invasive Approaches in the Management of Cervical Pregnancy

Minimal Invasive Approaches in the Management of Cervical Pregnancy

Diagnosis and Management of Cervical Pregnancy

Abstract Background: Cervical pregnancy is one of the rarest ectopic pregnancies, and it is often diagnosed as intrauterine pregnancy if careful examination is not undertaken. Termination of pregnancy can be hazardous, leading to hemorrhage when diagnosis is missed. Case: A 25-year-old woman, gravida 2, with a previous history of lower-segment cesarean delivery (LSCD) underwent medical termination of pregnancy (MTP) at 2 months of pregnancy, by pharmaceutical methods followed by dilatation and curettage. She did not undergo ultrasound examination prior to the procedure. She had continuous bleeding from her vagina for 25 days, and a transvaginal examination at the Jawaharlal Institute of Postgraduate Medical Education and Research showed an irregular gestational sac in the cervix below the internal os. Her β–human chorionic gonadotropin (β-hCG) was 146.2 (mIU)/mL, and she was treated with a variable dose of methotrexate. Results: This patient responded well to one course of methotrexate and her β-hCG norma...

Conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided local injection: an eight case series

Objective: To evaluate the efficacy of conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided local injection.Methods: Retrospective case series at University tertiary care Hospital. Eight patients diagnosed with cervical pregnancy with embryonic heart activity managed conservatively. The intervention was ultrasound-guided local injection of methotrexate (1 mg/kg) and potassium chloride (2 meq/mL). Measurements were occurrence of morbidity, necessity for further intervention, the initial titers of beta-hCG, interval of time in which the levels of beta-hCG became negative, period for regression of cervical pregnancy at ultrasound and future pregnancy.Results: All patients were treated successfully. The initial levels of beta-hCG ranged from 3013 to 71199 mUI/mL. One case evaluated with infection. There was no need for additional intervention in our series study. The interval of time for the levels of beta-hCG becomes negative range from 2 to 12 weeks. The period for the regression of the cervical pregnancy at ultrasound range from 3 to 14 weeks. In two cases intrauterine pregnancies occurred after the treatment.Conclusion: Conservative management of cervical pregnancy with embryonic heart activity by ultrasound-guided injection is an effective treatment avoiding the need of further intervention.

Cervical and Cesarean scar ectopic pregnancies: Diagnosis and management

Abstract Cervical pregnancies are rare in naturally conceived pregnancies and even after assisted reproductive technology. The ultrasonographic diagnosis rests upon the trophoblastic invasion of the cervix below the internal os. Several options have been used over the last three decades for the management of cervical pregnancy. The most successful treatments are methotrexate injection and uterine artery embolization (UAE). A step by step delineation of diagnosis and management is demonstrated in this manuscript that could aid the clinician in his management. Cesarean scar pregnancies (CSPs) are more commonly seen today, both in the East and the West, as a result of a significant increase in the proportion of Cesarean deliveries over the last three decades. The presence of a large number of management options highlights the fact that there is no standardized protocol for cervical pregnancy and CSP management. The advancement of laparoscopic management and suturing is the single most effective measure in confirmation as well as treatment of CSP. Optimal repair of uterine defect is essential for the prevention of another CSP.

Conservative management of cervical pregnancy: The utility of methotrexate treatment and uterine artery embolization

The aim of this retrospective case series report is to evaluate systemic methotrexate therapy in conjunction with uterine artery embolization (UAE) in the conservative management of cervical pregnancy. We examined clinical presentations, treatments, and therapeutic outcomes in fifteen patients with a cervical pregnancy who wished for preservation of fertility, treated at Okayama University Hospital between 1998 and 2012. Twelve patients received systemic methotrexate including five treated with UAE. One was treated with UAE alone. Two patients received neither UAE nor methotrexate because of a low human chorionic gonadotropin (hCG) level and poor blood flow around the gestational sac (GS). An increased GS size and the elevated hCG level during methotrexate therapy might be risk factors for emergent UAE. Two of six patients treated with UAE had subsequent confirmed viable pregnancies. In patients with a cervical pregnancy, methotrexate therapy in combination with UAE can be considered as an option before performing a hysterectomy with suitable counseling about the risk of loss of fertility. Careful observation of the GS size and hCG level during methotrexate therapy might be important for management.

Obstetrics and Gynaecology: Conservative Management of Cervical Pregnancy: A Case Report

Cervical pregnancy is a rare form of ectopic pregnancy, which accounts for less than 1% of all ectopic pregnancies. This case has been reported because of its rarity and successful treatment by methotrexate injection alone, in early viable pregnancy. A 25 year old G3P1L1E1 with history of previous caesarean section and previous abdominal pregnancy, presented with complaints of bleeding per vaginum for 10 days, after 7weeks of amenorrhoea. Transvaginal sonogram showed – single live intrauterine gestational sac with live fetal pole of CRL7.2mm in the cervical stroma, with surrounding increased vascularity. Her Beta-HCG was 53,280mIU/ml. Inj. Methotrexate 70mg i.m was given on Day1,3,5,7 and Inj. Folinic acid 7mg on Day2,4,6,8. Transvaginal ultrasound after 5days showed decrease in vascularity . Ultrasound after 1 week of treatment showed normal uterus and cervix. Beta HCG was 2300mIU/ml. Patient was on follow up with weekly serum beta-HCG. After seven weeks her Beta HCG became normal. Though studies have shown unsatisfactory results using methotrexate for Beta-HCG more than 10,000mIU/ml and cardiac activity is present, in our case we considered methotrexate, because vascularity will be reduced and bleeding will be less when we add other adjuvant conservative procedures. There are also studies showing treatment with methotrexate in viable cervical pregnancy less than12 weeks gestation carrying a high success rate. As with increasing caesarean section and artificial reproductive technique, there is increase in cervical pregnancy, a life threatening event. Early diagnosis allows early intervention and increases the likelihood of successful conservative treatment,there by preserving patient’s fertility. Methotrexate multidose regime as a conservative treatment is found out to be highly successful in viable cervical pregnancy.

P16.12: Management of cervical pregnancy

P16.12: Management of cervical pregnancy