Treatment Of Cervical Ectopic Pregnancy Research Articles

One-step total hysteroscopic removal of cervical ectopic pregnancy

Cervical ectopic pregnancy is a rare life-threatening obstetrical complication due to the potential of severe maternal hemorrhage. Hysterectomy was considered the gold standard treatment. However, advances in technology that allow early diagnosis have led to the development of alternative, more conservative treatments, including medical therapy and minimally invasive surgery. In this Surgeon's Corner article with accompanying video, we describe a one-step total hysteroscopic approach for the treatment of cervical ectopic pregnancy, performed in an asymptomatic patient with a non-viable cervical ectopic pregnancy at an early gestational age. The hysteroscopic resection was performed using a TruClear 5C mini-hysteroscope with dense tissue shaver. The patient was discharged 24 hours after the procedure with an uneventful postoperative course. We conclude that with proper patient selection, the one step total hysteroscopic approach for the treatment of cervical ectopic pregnancy may offer a surgical treatment that is effective and safe.

Bimodal approach for a case of cervical ectopic pregnancy

Ectopic pregnancy though rare can be a life threatening obstetric emergency without prompt diagnosis and treatment, can lead to significant mortality and morbidity. Incidence of Cervical ectopic pregnancy is <1%. The only viable option was hysterectomy in the past. However, at present various uterine conservative methods are available and can be life saving and drastically decreases the morbidity associated.28yrs G3P1L1A1 at 12 weeks 6 days of gestation with previous LSCS with previous history of Dilation & Evacuation came with USG report showing cervical ectopic pregnancy. Managed initially with 2doses of systemic methotrexate, in view of persistent complaints of spotting pervaginum patient underwent endocervical curettage.Early diagnosis and treatment of cervical ectopic pregnancy with combined approach can effectively reduce the chances of life threatening hemorrhage.

A rare case of cervical ectopic pregnancy

Cervical ectopic pregnancy is the implantation of conceptus in the cervical glands and fibrous cervical wall below the level of internal os. It is a rare and potentially life threatening condition associated with a high rate of maternal morbidity and accounts for less than 1% of all ectopic gestation. It may turn into an obstetric emergency, if not detected and treated early due to risk of severe hemorrhage. This entity can be diagnosed at early gestational age with help of ultrasonography and conservative approach of management help to preserve fertility. A 32- year female treated for secondary infertility via in-vitro fertilization(IVF) and embryo transfer(ET) with previous three dilation and curettage following previous missed conceptions presented with vaginal bleeding and Transvaginal ultrasonography revealed a cervical ectopic pregnancy of 5 weeks and 3 days with cardiac activity present. She was managed successfully by PGF2 alpha analogue administration preceding dilation and curettage of endocervical canal and cervical packing with hemocoagulase soaked gauze. Complete hemostasis was achieved and discharged after an uneventful hospital stay. Endocervical curettage is one of the minimally invasive management strategy in cervical ectopic pregnancy with cardiac activity and sufficient for full recovery with preservation of reproductive capacity. Our case demonstrates a new strategy combining systemic intramuscular prostaglandin and curettage for treatment of cervical ectopic pregnancy which may provide an efficient and safe alternative to embryocides at early gestational age.

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.

Successful Treatment of Cervical Ectopic Pregnancy with Multi Dose Methotrexate Therapy

Cervical ectopic pregnancies account for less than 1% of all pregnancies. Earlier, it was associated with significant hemorrhage and was treated presumptively with hysterectomy. With the advent of enhanced ultrasound techniques, early detection of these pregnancies has led to the development of more effective conservative management. We present a case of a cervical ectopic pregnancy successfully treated with multi-dose Methotrexate therapy. A 37-year-old lady, G3P0+2, pregnant for 9 weeks and 4 days, presented with bleeding per vagina, mild lower abdomen and back pain. Serum Beta-hCG done 5 days ago was 950 mIU/mL. She was diagnosed as ectopic cervical pregnancy by clinical examination which was confirmed by transvaginal ultrasonography and subsequently managed by Methotrexate (MTX) Hybrid double dose protocol. Due to rising Beta-hCG and continuous bleeding, it was modified to Multi dose Methotrexate Therapy. Thereafter, the patient was asymptomatic with falling beta-hCG and she was put on a weekly follow up in the clinic.

Diagnosis and treatment of cervical ectopic pregnancy - case report

Cervical pregnancy is a rare form of ectopic pregnancy with frequency less than 1%. Etiology is not sufficiently clarified, and a treatment depending on several factors begins with a conservative one, mainly in asymptomatic patients, and most often goes from methotrexate, through curettage to hysterectomy in case of profuse and life threatening bleeding. The present case reports a 35-year-old patient, without most commonly mentioned etiological factors for cervical pregnancy, who underwent curettage in eight weeks of amenorrhea with administration of a chemical coagulant, human fibrinogen, and human thrombin set.

Novel surgical approach for treatment of cervical ectopic pregnancy in IVF patient

Novel surgical approach for treatment of cervical ectopic pregnancy in IVF patient

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.

A Successful Treatment of Cervical Ectopic Pregnancy with Multidose Methotrexate

A Successful Treatment of Cervical Ectopic Pregnancy with Multidose Methotrexate

2092092 Persistent Cervical Hypervascularity after Treatment of Cervical Ectopic Pregnancy in A Series of 8 Cases

2092092 Persistent Cervical Hypervascularity after Treatment of Cervical Ectopic Pregnancy in A Series of 8 Cases

Cervical pregnancy treated by uterine artery embolisation combined with office hysteroscopy

To evaluate the safety and efficacy of uterine artery embolisation in conjunction with hysteroscopic resection of trophoblast in the conservative treatment of cervical ectopic pregnancies. Five women diagnosed with cervical pregnancies at University Hospital of Foggia, Italy, between May 2009 and February 2012 underwent uterine artery embolisation followed by office hysteroscopic resection of trophoblast. Data on operating time, blood loss, blood transfusion, conversion to other techniques, complications related to surgery, change of serum β-hCG level, hospitalisation days and outcome of the women after discharge were collected. The mean hysteroscopic operative time was 9.8 min, and the blood loss was negligible in all cases. Blood transfusion was not needed for any of the women. None of the women required conversion to other techniques. In all cases the operations were uneventful. The serum β-hCG level in all the cases declined to normal within 15 days of surgery. The total hospitalisation time was 4 days in all the cases. No vaginal bleeding or other side effects were observed throughout and after the treatment, all women recovered without complications. Uterine artery embolisation with office hysteroscopic resection is an effective option in treatment of cervical ectopic pregnancy.

Tratamiento del embarazo ectópico cervical con metotrexato y rescate con leucovorina

Objective To present two cases of cervical ectopic pregnancy successfully treated with systemic methotrexate. Subjects and methods Two women with a cervical ectopic pregnancy. Interventions: alternative day regime of methotrexate 1 mg/kg (days 1,3,5 and 7) with folinic acid rescue (days 2, 4, 6, and 8). End points: successful treatment. Results Two cases of ectopic cervical pregnancy were successfully treated and preserved their reproductive capability. Conclusions Conservative medical treatment of cervical ectopic pregnancy with systemic methotrexate is safe and effective.

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.

Diagnosis and treatment of cervical ectopic pregnancy

To investigate the diagnosis and treatment of cervical ectopic pregnancy. The clinical data of 27 patients with cervical ectopic pregnancy who were treated in Peking Union Medical College Hospital from January 1990 to November 2009 were retrospectively reviewed. The clinical effectiveness of three fertility-preserved treatment modes were compared. Of these 27 patients,one underwent hysterectomy, while all the other 26 patients selected fertility-preserved treatment,which included curettage after uterine artery embolization (UAE) (n=14), curettage directly (n=8), and curettage after methotrexate (MTX) injection (n=4). The effectiveness rates of these three methods were 100%,75.0%,and 50.0%, respectively,which was significantly higher in curettage after UAE group than in curettage after MTX group (P=0.005). The duration of hospitalization was (17.0∓3.2) days in curettage after MTX group,which was significantly longer than that in curettage after UAE group (6.1∓2.9) d (P=0.004) and curettage directly group (4.9∓3.4) d (P=0.001). The mean hospitalization cost showed no significant difference among three groups (P=0.104). Curettage after UAE is safe and effective for patients diagnosed or highly suspicious of cervical pregnancy.

Delayed spontaneous expulsion of a cervical ectopic pregnancy: A case report

Cervical ectopic pregnancy is an uncommon event. Modern diagnostic and treatment options provide an opportunity for conservative treatment of this condition. A case of a profuse hemorrhage associated with delayed spontaneous expulsion of a cervical ectopic pregnancy is described, and the management is discussed. In this patient, the cervical ectopic pregnancy was treated successfully using systemic methotrexate and selective uterine artery embolization. The patient returned 1 week later with spontaneous expulsion of the ectopic pregnancy associated with profuse hemorrhage. The bleeding subsided following tamponade using a transcervical Foley catheter. We conclude that conservative treatment of cervical ectopic pregnancy is feasible, with careful posttreatment surveillance.

Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound-guided aspiration and single-dose methotrexate

Objective To present a case of cervical ectopic pregnancy successfully treated with ultrasound-guided aspiration and single-dose methotrexate administered systemically. Design Case report. Setting University hospital. Patient(s) A 27-year-old nulliparous woman with a cervical ectopic pregnancy. Intervention(s) Transvaginal ultrasound-guided aspiration of the cervical ectopic pregnancy followed by single-dose methotrexate administered systemically. Main outcome measure(s) Recovery of the patient, successful conservative treatment of the cervical ectopic pregnancy, with preservation of the uterus. Result(s) The cervical ectopic pregnancy was successfully aborted, and the reproductive capability of the patient was preserved. Conclusion(s) Transvaginal ultrasound-guided aspiration in combination with single-dose methotrexate administered systemically can be safely used to treat cervical ectopic pregnancies.

Consecutive cervical pregnancies

Objective Report of a rare case of consecutive spontaneous cervical pregnancies. Design Case study. Setting Teaching hospital. Patient(s) One healthy nulliparous woman in the early years of her fourth decade. Intervention(s) The first of two cervical pregnancies was treated with two doses of methotrexate and subsequent uterine artery embolization. The second was treated with methotrexate, intracervical Foley catheter placement, hysteroscopic ablation of the bleeding cervical bed, and replacement of the Foley catheter with gradual deflation of balloon. Main outcome measure(s) Recognition and successful treatment of cervical ectopic pregnancy. Result(s) Each of the two cervical pregnancies was successfully treated. The patient subsequently carried a spontaneous intrauterine pregnancy to term. Conclusion(s) A comprehensive MEDLINE search revealed that this appears to be the first reported case of recurrent spontaneous cervical pregnancies, and only the second known case of recurrent cervical pregnancy. Cervical pregnancies have generally been treated with hysterectomy because of the potential for massive hemorrhage. However, current treatment options permit effective conservative management in women who desire continued fertility. This case illustrates various treatment options, under different circumstances, in the same individual.

Cervical ectopic pregnancy. Diagnosis with endovaginal ultrasound examination and successful treatment with methotrexate.

Cervical ectopic pregnancy is the implantation of a pregnancy in the endocervical canal. Diagnosis and treatment of cervical ectopic pregnancy has changed dramatically in the last 15 years. Before 1980, the diagnosis commonly was made when dilation and curettage for presumed incomplete abortion resulted in unexpected hemorrhage. Emergency hysterectomy usually ensued. Cervical ectopic pregnancy is now commonly diagnosed on a first-trimester ultrasound examination. The family physician practicing obstetrics must consider the diagnosis of cervical ectopic pregnancy in women with first-trimester vaginal bleeding or pelvic pain to permit early diagnosis and fertility-saving treatment. A case report of diagnosis and successful medical management of a cervical ectopic pregnancy is presented. The literature on the epidemiology, causes, diagnosis, and treatment of cervical ectopic pregnancy is reviewed.

Strategies for conservative treatment of cervical ectopic pregnancy.

Strategies for conservative treatment of cervical ectopic pregnancy.

Cervical ectopic pregnancy: results of conservative treatment.

To review experience with early sonographic diagnosis and fertility-preserving treatment of cervical ectopic pregnancy. The authors evaluated 12 consecutive cases of cervical ectopic pregnancy diagnosed with ultrasound (US) and treated with methods that successfully preserved the uterus. Gestational age, sonographic findings, means of conception, and method of treatment were recorded. Gestational age at diagnosis ranged from 5.0 to 7.9 weeks. Cardiac activity was documented in nine cases. Patients were treated as follows: transvaginal US-guided injection of potassium chloride into the embryo or gestational sac (n = 6), uterine artery embolization followed by dilation and evacuation (n = 4), dilation and evacuation after ligation of uterine artery branches (n = 1), and uterine artery embolization followed by administration of systemic methotrexate (n = 1). The cervical pregnancy was successfully ablated with one treatment in all cases. No patient required hysterectomy, and only one patient required transfusion. Two patients subsequently delivered healthy babies; three other patients have been able to conceive successfully. When cervical ectopic pregnancy is diagnosed early, US-guided termination or other conservative procedures allow preservation of the uterus, thus maintaining potential fertility.