An Algorithm for Treatment of Cervical Pregnancy: Report of a Series of Eight Patents
Abstract
Being considered as an important life-threatening condition, Cervical Pregnancy (CP) is defined as the implantation and growth of the gestational sac in the endocervical canal. Due to high maternal mortality and morbidity expectant management is not recommended. There is no definite treatment for this complication. During this case series study, we used an algorithm for CP treatment according to gestational age, presence of fetal heart activity, hemodynamic stability, and patients desire for future fertility in 8 patients. We used a combination of several modalities such as fetal heart reduction, systemic methotrexate, and uterine artery embolization to successfully treat all of them. Reproductivity ability of all patients has been reserved and 3 pregnancies including 2 terms and 1 preterm occurred during the follow-up period.
[1] Donnez O, Jadoul P, Squifet J, Donnez J. Laparoscopic repair of wide and deep uterine scar dehiscence afer cesarean secton. Fertlity and Sterility. 2008; 89(4):974-80. [DOI:10.1016/j.fertnstert.2007.04.024] [PMID]
[2] Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: Past and future. Obstetrical & Gynecological Survey. 1997; 52(1):45-59. [DOI:10.1097/00006254-199701000-00023] [PMID]
[3] Vela G, Tulandi T. Cervical pregnancy: The importance of early di- agnosis and treatment. Journal of Minimally Invasive Gynecology 2007; 14(4):481-4. [DOI:10.1016/j.jmig.2006.11.012] [PMID]
[4] Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR find- ings of cervical pregnancy. Journal of Magnetic Resonance Imaging: JMRI. 2001; 13(6):918-22. [DOI:10.1002/jmri.1131] [PMID]
[4] Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR find- ings of cervical pregnancy. Journal of Magnetic Resonance Imaging: JMRI. 2001; 13(6):918-22. [DOI:10.1002/jmri.1131] [PMID]
[5] Timor-Tritsch IE, Monteagudo A, Mandeville EO, Peisner DB, Anaya GP, Pirrone EC. Successful management of viable cervical pregnan- cy by local injection of methotrexate guided by transvaginal ultra- sonography. American Journal Of Obstetrics And Gynecology. 1994; 170(3):737-9. [DOI:10.1016/S0002-9378(94)70273-X]
[6] Jeng CJ, Ko ML, Shen J. Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstetrics and Gynecology. 2007; 109(5):1076- 82. [DOI:10.1097/01.AOG.0000262052.09350.52] [PMID]
[7] Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: A review and a report of two cases treated con- servatively. Ultrasound in Obstetrics & Gynecology. 1996; 8(6):373- 80. [DOI:10.1046/j.1469-0705.1997.08060373.x] [PMID]
[8] Hung TH, Jeng CJ, Yang YC, Wang KG, Lan CC. Treatment of cervi- cal pregnancy with methotrexate. International Journal of Gy- necology & Obstetrics. 1996; 53(3):243-7. [DOI:10.1016/0020- 7292(96)02653-7]
[9] Dotters DJ, Katz VL, Kuller JA, McCoy MC. Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen. Eu- ropean Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995; 60(2):187-9. [DOI:10.1016/0028-2243(95)02039-U][PMID]
[10] Fylstra DL. Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. American Journal of Obstet- rics and Gynecology. 2014; 210(6):581.e1-5. [DOI:10.1016/j. ajog.2014.03.057] [PMID]
[11] Doubilet PM, Benson CB, Frates MC, Ginsburg E. Sonographi- cally guided minimally invasive treatment of unusual ectopic preg- nancies. Journal of Ultrasound in Medicine. 2004; 23(3):359-70. [DOI:10.7863/jum.2004.23.3.359] [PMID]
[12] Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: Utility of uterine artery embolization. Fertility and Sterility. 2011; 95(3):872-6 [DOI:10.1016/j.fertnstert.2010.12.024] [PMID]
[13] Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake MD, Razavi MK. Pelvic arterial embolization for control of obstetric hemorrhage: A five-year experience. American Journal of Obstetrics and Gynecology. 1999; 180(6 Pt 1):1454-60. [DOI:10.1016/S0002-9378(99)70036-0]
[14] Kim TJ, Seong SJ, Lee KJ, et al. Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate. Jour- nal of Korean Medical Science. 2004; 19(6):848-52. [DOI:10.3346/ jkms.2004.19.6.848] [PMID] [PMCID]
[15] Wang YL, Su TH, Chen HS. Laparoscopic management of an ec- topic pregnancy in a lower segment cesarean section scar: A review and case report. Journal of Minimally Invasive Gynecology. 2005; 12(1):73-9. [DOI:10.1016/j.jmig.2004.12.001] [PMID]
[16] Murji A, Garbedian K, Thomas J, Cruickshank B. Conservative Management of Cervical Ectopic Pregnancy. Journal of Obstetrics and Gynaecology Canada. 2015; 37(11):1016-20 [DOI:10.1016/ S1701-2163(16)30051-2]
[17] Verma U, Goharkhay N. Conservative management of cervi- cal ectopic pregnancy. Fertilty and Sterility. 2009; 91(3):671-4. [DOI:10.1016/j.fertnstert.2007.12.054] [PMID]
[18] Hwang JH, Lee JK, Oh MJ, Lee NW, Hur JY, Lee KW. Classification and management of cervical ectopic pregnancies: Experience at a single institution. Journal of Reproductive Medicine for the Obste- trician and Gynecologist. 2010; 55(11-12):469-76. https://koreau- niv.pure.elsevier.com/en/publications/classification-and-manage- ment-of-cervical-ectopic-pregnancies-exp
[2] Ushakov FB, Elchalal U, Aceman PJ, Schenker JG. Cervical pregnancy: Past and future. Obstetrical & Gynecological Survey. 1997; 52(1):45-59. [DOI:10.1097/00006254-199701000-00023] [PMID]
[3] Vela G, Tulandi T. Cervical pregnancy: The importance of early di- agnosis and treatment. Journal of Minimally Invasive Gynecology 2007; 14(4):481-4. [DOI:10.1016/j.jmig.2006.11.012] [PMID]
[4] Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR find- ings of cervical pregnancy. Journal of Magnetic Resonance Imaging: JMRI. 2001; 13(6):918-22. [DOI:10.1002/jmri.1131] [PMID]
[4] Jung SE, Byun JY, Lee JM, Choi BG, Hahn ST. Characteristic MR find- ings of cervical pregnancy. Journal of Magnetic Resonance Imaging: JMRI. 2001; 13(6):918-22. [DOI:10.1002/jmri.1131] [PMID]
[5] Timor-Tritsch IE, Monteagudo A, Mandeville EO, Peisner DB, Anaya GP, Pirrone EC. Successful management of viable cervical pregnan- cy by local injection of methotrexate guided by transvaginal ultra- sonography. American Journal Of Obstetrics And Gynecology. 1994; 170(3):737-9. [DOI:10.1016/S0002-9378(94)70273-X]
[6] Jeng CJ, Ko ML, Shen J. Transvaginal ultrasound-guided treatment of cervical pregnancy. Obstetrics and Gynecology. 2007; 109(5):1076- 82. [DOI:10.1097/01.AOG.0000262052.09350.52] [PMID]
[7] Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: A review and a report of two cases treated con- servatively. Ultrasound in Obstetrics & Gynecology. 1996; 8(6):373- 80. [DOI:10.1046/j.1469-0705.1997.08060373.x] [PMID]
[8] Hung TH, Jeng CJ, Yang YC, Wang KG, Lan CC. Treatment of cervi- cal pregnancy with methotrexate. International Journal of Gy- necology & Obstetrics. 1996; 53(3):243-7. [DOI:10.1016/0020- 7292(96)02653-7]
[9] Dotters DJ, Katz VL, Kuller JA, McCoy MC. Successful treatment of a cervical pregnancy with a single low dose methotrexate regimen. Eu- ropean Journal of Obstetrics, Gynecology, and Reproductive Biology. 1995; 60(2):187-9. [DOI:10.1016/0028-2243(95)02039-U][PMID]
[10] Fylstra DL. Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade. American Journal of Obstet- rics and Gynecology. 2014; 210(6):581.e1-5. [DOI:10.1016/j. ajog.2014.03.057] [PMID]
[11] Doubilet PM, Benson CB, Frates MC, Ginsburg E. Sonographi- cally guided minimally invasive treatment of unusual ectopic preg- nancies. Journal of Ultrasound in Medicine. 2004; 23(3):359-70. [DOI:10.7863/jum.2004.23.3.359] [PMID]
[12] Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: Utility of uterine artery embolization. Fertility and Sterility. 2011; 95(3):872-6 [DOI:10.1016/j.fertnstert.2010.12.024] [PMID]
[13] Hansch E, Chitkara U, McAlpine J, El-Sayed Y, Dake MD, Razavi MK. Pelvic arterial embolization for control of obstetric hemorrhage: A five-year experience. American Journal of Obstetrics and Gynecology. 1999; 180(6 Pt 1):1454-60. [DOI:10.1016/S0002-9378(99)70036-0]
[14] Kim TJ, Seong SJ, Lee KJ, et al. Clinical outcomes of patients treated for cervical pregnancy with or without methotrexate. Jour- nal of Korean Medical Science. 2004; 19(6):848-52. [DOI:10.3346/ jkms.2004.19.6.848] [PMID] [PMCID]
[15] Wang YL, Su TH, Chen HS. Laparoscopic management of an ec- topic pregnancy in a lower segment cesarean section scar: A review and case report. Journal of Minimally Invasive Gynecology. 2005; 12(1):73-9. [DOI:10.1016/j.jmig.2004.12.001] [PMID]
[16] Murji A, Garbedian K, Thomas J, Cruickshank B. Conservative Management of Cervical Ectopic Pregnancy. Journal of Obstetrics and Gynaecology Canada. 2015; 37(11):1016-20 [DOI:10.1016/ S1701-2163(16)30051-2]
[17] Verma U, Goharkhay N. Conservative management of cervi- cal ectopic pregnancy. Fertilty and Sterility. 2009; 91(3):671-4. [DOI:10.1016/j.fertnstert.2007.12.054] [PMID]
[18] Hwang JH, Lee JK, Oh MJ, Lee NW, Hur JY, Lee KW. Classification and management of cervical ectopic pregnancies: Experience at a single institution. Journal of Reproductive Medicine for the Obste- trician and Gynecologist. 2010; 55(11-12):469-76. https://koreau- niv.pure.elsevier.com/en/publications/classification-and-manage- ment-of-cervical-ectopic-pregnancies-exp
| Files | ||
| Issue | Vol 5 No 4 (2020): Autumn | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v5i4.5051 | |
| Keywords | ||
| Cervical pregnancy Systemic methotrexate Uterine artery embolizaton | ||
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How to Cite
1.
Tarafdari A, Borna S, Janatrostami S, Farajzadeh Vajari F. An Algorithm for Treatment of Cervical Pregnancy: Report of a Series of Eight Patents. CRCP. 2021;5(4):101-105.
