[Clinical comparison of four treatment methods for cesarean scar pregnancy]

OBJECTIVE

To explore the best approach to treatment of cesarean scar pregnancy (CSP).

METHODS

A total of 138 patients with CSP treated between January and December, 2013 were retrospectively analyzed. The patients were treated with conservative drug therapy, direct curettage, uterine curettage after embolization, or open or transvaginal surgery. The amount of blood loss, proportion of patients with blooding loss greater than 50 mL, hospitalization days, and hospitalization expenses were compared among the groups.

RESULTS

The median volume of blood loss was 370 mL in the conservative treatment group, 59 mL in direct curettage group, 67 mL in interventional therapy group, and 1425 mL in the surgical group, and the proportion of patients with blood loss over 50 mL was 76.9%, 38.8%, 27.5%, and 100% in the 4 groups, respectively. The midian hospital stay of the 4 groups was 9.0, 4.0, 6.0 and 10.0 days, with median hospitalization expenses of 12281.0, 3843.5, 14805.0, and 17202.2 RMB Yuan, respectively. All these data were significantly different among the 4 groups (P<0.05).

CONCLUSION

Direct curettage surgery should be encouraged for treatment of CSP. Embolization therapy can reduce the risk of bleeding but is associated with potential complications and more costly, and should be performed with caution. Open or trasnvaginal surgery can be considered in difficult cases of CSP, and its combination with interventional therapy is an option to better preserving the uterus.

[Vaginal impingement of uterine arteries (Zea technique) prior to cervical curettage in cervical ectopic pregnancy: three case report and literature review]

Cervical ectopic pregnancy is a rare and danger clinical presentation because it has high risk of massive bleeding. The incidence is reported in 1:2500 pregnancies and has high relation with a history of cervical dilatation and curettage and assisted reproductive techniques. Advances in ultrasound resolution and use of beta fraction of human chorionic gonadotropin allow early diagnosis and provide conservative treatment with decreased morbidity, mortality and fertility preservation. Various techniques have been reported associated with cervical curettage, to reduce bleeding at the implantation site. In this report three cases of cervical ectopic pregnancy managed with cervical curettage, prior vaginal impingement of uterine arteries (Zea Technique) at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes are described. The Zea technique represents an effective option in the control of obstetric hemorrhage, including patients diagnosed with cervical ectopic pregnancy in who the bleeding volume decrease after its placement. The Zea Technique is easy to apply and preserves fertility. The success of combining this technique with endocervical curettage for the management of cervical ectopic pregnancy is demonstrated. Training for performing this technique does not require highly specialized or highly complex resources since the required material is the usual every area of obstetric care.

Pregnancy of unknown location: Outcome in a tertiary care hospital

OBJECTIVE

To find out the outcome of a cohort of women with pregnancy of unknown location presenting to a tertiary care hospital.

METHODS

The prospective study was conducted from January to December, 2011, at Early Pregnancy Assessment Unit, King Faisal Military Hospital, Khamis Mushait, Saudi Arabia. Data was collected for women with early pregnancy or with history of amenorrhoea, bleeding or pain. These women were investigated with serum beta-human chorionic gonadotrophin levels twice weekly and transvaginal ultrasonography weekly. Expectant management was done for failing pregnancy of unknown location while medical or surgical management was considered for persistent pregnancy of unknown location and ectopic pregnancy.

RESULTS

During study period, 7215 patients were admitted, and, of them, 2212(30.6%) were patients with early pregnancy. Meeting the inclusion criteria were 183(2.53%) patients who formed the study sample. There were 131(71.6%) patients presenting with amenorrhoea, 90(49.2%) had bleeding and 93(50.8%) presented with pain. Outcome of 100(54.6%) patients was failing pregnancy of unknown location, 58(31.7%) had intrauterine pregnancy, 14(7.7%) converted to ectopic pregnancy, while 11(6%) had persistent pregnancy of unknown location. All patients with persistent pregnancy of unknown location and 5(36%) patients with ectopic pregnancy were medically treated. Five (36%) patients having ectopic pregnancy were managed surgically.

CONCLUSIONS

Management of choice for asymptomatic patients having pregnancy of unknown location is expectant management. Most of the patients suspected to have Most of the patients with persistent pregnancy of unknown location and ectopic pregnancy can be managed medically.

Managing Caesarean Scar Pregnancy in low Resource Settings: 2 Case Reports and a Description of Transrectal Ultrasound guided Surgical Approach (TRUGA)

Caesarean scar pregnancy (CSP) occurs when an embryo implants in a previous caesarean section scar. It has a reported incidence of 1 in 1800. Various surgical and medical techniques have been described in case reports for the management of CSP. These techniques are usually undertaken in tertiary level units with significant resource availability. In this paper, we present a new clinical perspective for the management of CSP in low resource settings and describe the steps involved in a transrectal ultrasound guided approach with dilatation of uterine cervix and subsequent evacuation of uterine contents (TRUGA with D&C).

Natural history of early first-trimester pregnancies implanted in Cesarean scars

OBJECTIVE

To describe the ultrasound findings and natural history of pregnancies implanted within or on Cesarean section scars in the first trimester of pregnancy.

METHODS

This was a prospective observational study of 10 women diagnosed with a pregnancy implanted in or on a Cesarean section scar in the first trimester, who declined medical intervention because of their desire to continue the pregnancy. The study population comprised women at < 12 weeks' gestation who were seen in our early pregnancy unit between January 2011 and September 2013. Nine women were followed up by serial ultrasound examinations and had detailed care plans for delivery at King's College Hospital (KCH). One woman was followed up and delivered at another teaching hospital. The first-trimester ultrasound findings were compared with the clinical outcome of the pregnancy.

RESULTS

The nine patients who were followed up at KCH developed ultrasound findings of morbidly adherent placenta (MAP) in the second and third trimesters. All 10 patients were diagnosed with MAP at the time of delivery by Cesarean section. The gestational age at delivery ranged from 26 to 38 weeks. The uterus was conserved in five patients, and Cesarean hysterectomy was performed in the remaining five. All three women with complete implantation of the gestational sac within the scar and two of three cases with placental lakes in the first trimester had hysterectomies. The two cases with bulging of the gestational sac out of the uterine contour had a preterm emergency hysterectomy due to placenta percreta. Histology confirmed placenta accreta in the five hysterectomy specimens. There were no fetal or neonatal complications.

CONCLUSIONS

Implantation of a pregnancy on or in a Cesarean section scar is a precursor of MAP; however, the degree of morbidity associated with this implantation is variable and difficult to predict based on first-trimester ultrasound findings only. The assessment of ongoing pregnancies implanted in Cesarean scars is most beneficial when performed between 7 and 9 weeks' gestation. Complete implantation within the myometrial defect, bulging of the trophoblast from the uterine contour and large placental lakes in the first trimester are ultrasound findings that may predict severe placenta accreta or percreta and consequently a poor outcome.

[Clinical analysis on selective uterine artery embolization combined with hysteroscopic surgery for exogenous cesarean scar pregnancy in 67 cases]

OBJECTIVE

To investigate the safety and feasibility of uterine arterial embolization (UAE) combined with hystersocpic excisionl of exogenous cesarean scar pregnancy (CSP).

METHODS

Totally 67 patients with exogenous CSP treated with selective UAE combined with hysterscopic surgery in Shengjing Hospital of China Medical University were analyzed retrospectively; 35 patients in Group A (thickness of the cesarean scar > 3 mm), while 32 patients in Group B (thickness of the cesarean scar ≤ 3 mm). The following clinical parameters including operative time, intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return of β-hCG to normal were compared.

RESULTS

All hysterscopic procedures were successfully completed in Group A, and only one case underwent a second hysteroscopic excision due to the 1-month postoperative ultrasound examination indicating a mass located in the cesarean scar and a slow decline of β-hCG. Three cases of Group B were transformed to laparoscopic or laparotomy operation and 7 cases underwent a second surgery. The volume of introperative blood loss was (97 ± 41) ml in Group A and (161 ± 92) ml in Group B, the difference was statistically significant (P < 0.01). But the operative time, quantity of postoperative uterine drainage, postoperative hospital days, the time for the retrun of β-hCG to normal and the mass absorption in Group A were (36 ± 9) minutes, (38 ± 13) ml, (3.5 ± 0.5) days, (26 ± 5) days, (82 ± 17) days, in Group B were (37 ± 9) minutes, (42 ± 16) ml, (4.0 ± 0.7) days, (28 ± 8) days, (88 ± 15) days, respectively, the differences were not statistically significant (all P > 0.05).

CONCLUSIONS

For exogenous CSP, when the thickness of cesarean scar is ≤ 3 mm, whether or not undertaking UAE, it should be seen as contraindication of hysterscopic surgery. UAE combined with hysterscopic surgery for the treatment of exogeous CSP with the cesarean scar thickness > 3 mm is safe and feasible according to patients condition and should be performed by experienced hysteroscopist.

[Analysis of 43 cases of cesarean scar pregnancy treated with suction curettage under ultrasound guidance]

OBJECTIVE

To evaluate the feasibility and safety of transabdominal ultrasound-guided suction curettage to treat cesarean scar pregnancy (CSP) and investigate factors affecting prognosis of CSP.

METHODS

This was a retrospective case study of 43 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance as an initial treatment of CSP in Obstetrics and Gynecology Hospital of Fudan University over past 7 years (from 2007 to 2013); factors affecting prognosis of CSP were investigated.

RESULTS

39 of the 43 cases (91%) were successfully treated. There were no statistically significant differences in maternal age, gravidity, abortion frequency, and the time interval between current CSP and last cesarean delivery, the myometrium thickness between the gestational sac and the bladder wall between the success group and the failure group (all P > 0.05). Statistically significant difference was found in crown-rump length (CRL) between the two group (median of the two group was 18.5, 2.0 mm) by rank sum test (P = 0.047). Univariate logistic regression analysis demonstrated that CRL was strongly associated with the prognosis and the OR for no complications was 18.50, comparing CRL ≤ 6 mm versus CRL > 6 mm (P = 0.020).

CONCLUSION

Transabdominal ultrasound-guided suction curettage is effective and safe in the treatment of CSP with CRL ≤ 6 mm.

CT findings of omental pregnancy: a case report

Omental pregnancy is an extremely rare and dangerous form of ectopic pregnancy which can be very difficult to diagnose radiologically. We report the case of an 18-year-old girl with secondary omental pregnancy who was assessed by use of contrast-enhanced computed tomography (CT). For the first time, we report the contrast-enhanced CT features of omental pregnancy. Inhomogeneous mild enhancement was observed, which is different from other kinds of ectopic pregnancy, for which enhancement is often substantial. Possible reasons for the discrepancy are discussed, as also is differential diagnosis of omental pregnancy.

[Cervical ectopic pregnancy. Hysteroscopy treatment, case report]

The cervical ectopic pregnancy is extremely rare accounting for approximately 0.1% of all ectopic pregnancies. The incidence is estimated at 1:2500-1:98,000 pregnancies. Before the decade of the 80s, the diagnosis is usually performed to made curettage for incomplete abortion likely secondary to uncontrollable bleeding culminating in hysterectomy, is extremely dangerous, as the trophoblast uterine vessels can reach through the thin wall cervical and cause serious and intractable bleeding that usually ends even today in mutilating surgeries to limit future playback. Currently exist no clear criteria in the literature to help decision-making. We report a case of cervical pregnancy successfully treated by operative hysteroscopy ablation and proposes criteria that could help in the future to address this devastating disease.

Robotic-assisted laparoscopic removal of cesarean scar ectopic and hysterotomy revision

A 38-year-old gravida 6 para 2042 woman presented in consultation regarding management of a uterine defect, or "niche," following resolution of a cesarean scar ectopic pregnancy. She had 3 prior losses, followed by in vitro fertilization that resulted in 2 healthy births, both delivered by cesarean. A third in vitro embryo transfer resulted in the cesarean scar ectopic. After consideration of treatment options, she underwent multiple-dose parenteral methotrexate with eventual termination of the ectopic. Magnetic resonance imaging demonstrated a uterine defect, suspected to contain residual pregnancy tissue. Questions considered in her consultation included whether the defect should be repaired and, if so, from a hysteroscopic or laparoscopic approach, as well as her risk of intrauterine scarring, when, or if, it would be safe to pursue another pregnancy, and her subsequent risk of uterine rupture. Literature review regarding cesarean niche was helpful, but did not seem to completely inform this particular clinical scenario. She elected to proceed with robotic-assisted laparoscopic repair. The vesicovaginal space was opened to expose the defect. Dilute vasopressin was injected circumferentially around the defect to help minimize the use of electrosurgery in opening the hysterotomy. Scar overlying the defect was resected and pregnancy tissue removed. The hysterotomy was closed with delayed-absorbable barbed suture, extrapolating technique from laparoscopic myomectomy. The first layer was imbricated with a second, similar to a 2-layer closure in cesarean delivery. Follow-up magnetic resonance imaging revealed resolution of the defect. After several failed attempts at repeat in vitro fertilization, spontaneous pregnancy was achieved 18 months postoperatively. The pregnancy was uncomplicated and she underwent scheduled cesarean delivery of a healthy neonate at 37 weeks' gestation. The lower uterine segment was thick and developed, with no evidence of a dehiscence.

[Cervical ectopic pregnancy of 16 weeks gestation. Block with preventive hysterectomy surgical technique for massive pelvic hemorrhage. Case report]

Obstetric hemorrhage remains the leading cause of maternal death, we continue to insist on preventive management of patients at high risk of massive pelvic bleeding, uterine dearterialization selective, significantly reduces the morbidity and mortality of the patient, on this ocassion we report the case of a 33-year-old with a diagnosis of cervical ectopic pregnancy of 13 gestational weeks, treated with selective dearterialization of hypogastric arteries with excellent results, without postoperative complications.

High-intensity focused ultrasound combined with suction curettage for the treatment of cesarean scar pregnancy

The aim of this study was to retrospectively evaluate the safety and feasibility of high-intensity focused ultrasound (HIFU) treatment combined with suction curettage under hysteroscopic guidance for cesarean scar pregnancy (CSP).Fifty-three patients with definite CSP were treated with HIFU followed by suction curettage under hysteroscopic guidance. All the patients received 1 session of HIFU ablation under conscious sedation. Suction curettage under hysteroscopic guidance was performed at an average of 2.9 (range: 1-5) days after HIFU ablation. Blood flow of pregnancy tissue before and after HIFU, intraoperative blood loss in suction curettage and hysteroscopy procedure, time for β-human chorionic gonadotropin (β-hCG) to return to normal level, and time for normal menstruation recovery were recorded.Immediately after HIFU treatment, color Doppler ultrasound showed that the fetal cardiac activity disappeared and the blood flow in the pregnancy tissue significantly decreased. All the patients underwent suction curettage under hysteroscopic guidance after the treatment of HIFU, the median volume of blood loss in the procedure was 20 mL (range: 10-400 mL). The average time for menstruation recovery was 35.1 ± 8.1 (range: 19-60) days. The average time needed for serum β-hCG to return to normal levels was 27.5 ± 6.4 (range: 12-40) days. The average hospital stay was 7.8 ± 1.5 (range: 5-11) days.Based on our results, it appears that HIFU combined with suction curettage under hysteroscopic guidance is safe and effective in treating patients with CSP at gestational ages <8 weeks.

Pregnancy of unknown location

The development of highly sensitive and accurate human chorionic gonadotropin assays as well as the improvement of vaginal ultrasound have allowed for the early detection of pregnancy and have reduced the morbidity and mortality associated with ectopic gestations. One of the byproducts of this increased sensitivity is pregnancy of unknown location (PUL), a term which is used to describe pregnancy in a woman with a positive pregnancy test but no signs of intrauterine or extrauterine pregnancy. A PUL can include an early intrauterine pregnancy, a failing intrauterine/extrauterine pregnancy or ectopic pregnancy. Modern medical management has improved the diagnosis and treatment of early pregnancy and pregnancy loss. In the hemodynamically stable patient with PUL, expectant management has been shown to be safe and allows for confirmatory studies before proceeding with therapy.

Ruptured ipsilateral ectopic pregnancies: a rare emergency case series

Ectopic pregnancy is one of the most important causes of maternal mortality in first trimester pregnancy. Several etiologic factors are suspected for ectopic pregnancy. Fertility-saving surgery in ectopic pregnancy is associated with recurrent ectopic pregnancy. Most common site of ectopic pregnancy is in the fallopian tube, especially in the ampullar region. Ipsilateral tube is rare site for ectopic pregnancy. Previous tubal surgery, especially partial salpingectomy, is an important factor in this disease.

Recurrent ectopic pregnancy after ipsilateral partial salpingectomy: a case report

Ectopic pregnancy is associated with maternal morbidity and mortality during early pregnancy. Ectopic pregnancy occurs in approximately 2% of all pregnancies, and the risk of ectopic pregnancy is increased by eight-fold in women with a history of eopic pregnancy. However, recurrent ectopic pregnancy after ipsilateral partial salpingectomy is quite rare. The authors experienced a case of recurrent ectopic pregnancy in the distal remnant after right partial salpingectomy. In this case report, they discuss this unusual case and provide a brief review of the literature.

A different technique for the closure of trocar sites

This study aims to present a different technique for the closure of trocar sites in laparoscopic surgeries.

MATERIALS AND METHODS

Retrospective records of cases who received the new closure technique were collected. Multifilament synthetic absorbable suture was used in this technique, with no additional tools.

RESULTS

This technique was applied in a total of ten cases, which included myomectomy, hysterectomy, sacrocolpopexy, and ectopic pregnancy. No intraoperative and postoperative complications were seen in any of the cases.

CONCLUSION

This new and relatively easy-to-use technique can be used as an alternative technique for the closure of trocar sites in laparoscopy.

Cervical ectopic pregnancy managed with methotrexate and tranexamic acid: A case report

BACKGROUND

Cervical pregnancy is a rare life-threatening form of ectopic pregnancy and when it occurs, it is challenging to decide the management options. Surgical intervention has been documented to be complicated by intractable haemorrhage and most often necessitating hysterectomy. We hereby report a case of cervical pregnancy managed conservatively with medical agents prior to surgical intervention. CASE PRESENTATION AND MANAGEMENT: A 29 year old primiparous woman with gestational diabetes mellitus who presented at 10 weeks gestation with 5 days history of brownish vaginal discharge and 2 days history of painless vaginal bleeding. On pelvic examination the cervix was disproportionately larger than the uterus with a closed internal os. Transvaginal and abdominal ultrasound scanning confirmed a live cervical pregnancy. She had intramuscular methotrexate and tranexamic acid followed by suction evacuation combined with balloon tamponade. Examination at 6 weeks post procedure revealed a normal cervix.

CONCLUSION

Cervical pregnancy still occurs in this environment despite its rarity. Surgical intervention usually results in hysterectomy and adopting medical management as a first line treatment option offers the benefit of uterine preservation.

Procedural specificity in laparoscopic simulator training: protocol for a randomised educational superiority trial

BACKGROUND

The use of structured curricula for minimally invasive surgery training is becoming increasingly popular. However, many laparoscopic training programs still use basic skills and isolated task training, despite increasing evidence to support the use of training models with higher functional resemblance, such as whole procedural modules. In contrast to basic skills training, procedural training involves several cognitive skills such as elements of planning, movement integration, and how to avoid adverse events. The objective of this trial is to investigate the specificity of procedural practice in laparoscopic simulator training.

METHODS/DESIGN

A randomised single-centre educational superiority trial. Participants are 96 surgical novices (medical students) without prior laparoscopic experience. Participants start by practicing a series of basic skills tasks to a predefined proficiency level on a virtual reality laparoscopy simulator. Upon reaching proficiency, the participants are randomised to either the intervention group, which practices two procedures (an appendectomy followed by a salpingectomy) or to the control group, practicing only one procedure (a salpingectomy) on the simulator. 1:1 central randomisation is used and participants are stratified by sex and time to complete the basic skills. Data collection is done at a surgical skills centre.The primary outcome is the number of repetitions required to reach a predefined proficiency level on the salpingectomy module. The secondary outcome is the total training time to proficiency. The improvement in motor skills and effect on cognitive load are also explored.

DISCUSSION

The results of this trial might provide new knowledge on how the technical part of surgical training curricula should be comprised in the future. To examine the specificity of practice in procedural simulator training is of great importance in order to develop more comprehensive surgical curricula.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02069951.

[Cornual ectopic pregnancy]

This paper reports the case of a 16-year old patient, with menstrual delay of 9 weeks, with positive pregnancy test, who went to the hospital due to expulsion of organized material, as well as pain colic type in hypogastrium. It was carried out laparotomy, finding ectopic pregnancy in right horn, being carried out miometrial incision and trophoblast aspiration, with presence of multiple endometriosic focuses in later face of uterus. In later pregnancies, there are not studies about the solidity of the scar after the horn resection and uterine breaks have been described in the second and third trimester.

Successful term delivery after laparoscopic resection of a non-communicating rudimentary horn in a patient with a unicornuate uterus: a case report

Unicornuate uterus accompanied by a non-communicating rudimentary horn is a rare uterine malformation. If a embryo is implanted into the rudimentary horn, continuation of pregnancy is difficult due to the risk of uterine rupture. We recently performed laparoscopic resection of the right rudimentary horn after two right rudimentary horn pregnancies in a woman, in whom a normal pregnancy occurred in the left unicornuate uterus, leading to successful delivery of a baby. This case is presented herein. The diagnostic procedures leading to identification of this rare malformation were prompted by inability to remove uterine contents during surgery performed after a diagnosis of missed abortion. A right rudimentary horn pregnancy, which had occurred twice, was treated with methotrexate. To prevent further pregnancy in the right rudimentary horn, resection of this rudimentary horn was planned and successfully implemented under laparoscopic guidance. This surgical procedure is usually difficult, but fertility could be preserved by employing minimally invasive surgery, involving the use of a LigaSureTM Vessel Sealing System to avoid ligation and assure virtually no bleeding. Soon after surgery, a natural pregnancy in the left unicornuate uterus was confirmed. Intrauterine fetal growth was normal, and transvaginal delivery at term was possible.

A five year review of ectopic pregnancy at Federal Medical Centre, Owerri, South East, Nigeria

BACKGROUND

Ectopic pregnancy remains a leading cause of maternal morbidity and mortality in the first trimester of pregnancy in developing countries.

OBJECTIVES

To determine the incidence, pattern of presentation and management of ectopic pregnancies at Federal Medical Centre (FMC) Owerri.

METHODS

This was a retrospective descriptive study of all cases of ectopic gestations managed at FMC Owerri between 1st January 2009 and 31st December, 2013. The case notes were retrieved from the hospital's Records Department and information on socio-demographic characteristics, age, and parity, clinical presentation, findings at laparotomy, estimated blood loss and the need for blood transfusion were obtained. Data were entered into SPSS 17.0 and analysed descriptively.

RESULTS

There were 382 cases of ectopic gestations out of the total 9880 total deliveries within the study period. The incidence of ectopic pregnancy was 38.66 per 1,000 live births or I in 26 deliveries. Nulliparous women were 132 (34.5%). At presentation, 99.47% of patients had rupture with haemoperitoneum, with the commonest site being the ampulla of the fallopian tube as seen in 338 (88.4%). Salpingectomy was done in majority of cases, accounting for 355 (93%), while 248 (65%) had blood transfusion. Five (1.3%) maternal deaths occurred during period of study.

CONCLUSION

Ectopic pregnancy presents a major public health challenge among women of reproductive age groups in Nigeria. Efforts should be directed to public awareness on sex education, contraception, prevention and treatment of common risk factors for ectopic pregnancy.

Diagnosis and management of ectopic pregnancy

Ectopic pregnancy affects 1% to 2% of all pregnancies and is responsible for 9% of pregnancy-related deaths in the United States. When a pregnant patient presents with first-trimester bleeding or abdominal pain, physicians should consider ectopic pregnancy as a possible cause. The patient history, physical examination, and imaging with transvaginal ultrasonography can usually confirm the diagnosis. When ultrasonography does not clearly identify the pregnancy location, the physician must determine whether the pregnancy is intrauterine (either viable or failing) or ectopic. Use of the beta subunit of human chorionic gonadotropin (ß-hCG) discriminatory level, the ß-hCG value above which an intrauterine pregnancy should be visualized by transvaginal ultrasonography, may be helpful. Failure to visualize an intrauterine pregnancy when ß-hCG is above the discriminatory level suggests ectopic pregnancy. In addition to single measurements of ß-hCG levels, serial levels can be monitored to detect changes. ß-hCG values in approximately 99% of viable intrauterine pregnancies increase by about 50% in 48 hours. The remaining 1% of patients have a slower rate of increase; these patients may have pregnancies that are misdiagnosed as nonviable intrauterine or ectopic. After an ectopic pregnancy has been confirmed, treatment options include medical, surgical, or expectant management. For patients who are medically unstable or experiencing life-threatening hemorrhage, a surgical approach is indicated. For others, management should be based on patient preference after discussion of the risks, benefits, and monitoring requirements of all approaches.

[Modern possibilities of prophylaxis of intraoperative complications in organ salvage operations on the small pelvis organs]

Results of organpreserving operations on a small pelvis organs, performed in 337 patients-women, were analyzed. While heightened bleeding capacity of tissues in 39.3% women-patients when performing plastic operations on uterine tubes for ectopic pregnancy, cystectomy and conservative myomectomy with objective to stop hemorrhage the bleeding cessating plate Tachocomb was applied. It have permitted to perform organpreserving operations, to avoid complications, connected with intraoperative hemorrhage. Inclusion of Serrata preparation into rehabilitation therapy have promoted lowering of the pain syndrome severity and rate of occurrence of the adhesions process postoperatively.

Cervical pregnancy: 13 cases treated with suction curettage and balloon tamponade

OBJECTIVE

With no single regimen recognized as the standard for the treatment of first trimester cervical pregnancy, this report offers a successful treatment option with suction curettage and balloon tamponade.

STUDY DESIGN

This is a retrospective review, with institutional review board approval, of 13 consecutive first trimester cervical pregnancies, from 1995-2014, all treated with the same surgical technique by the author.

RESULTS

Successful termination of thirteen consecutive first trimester cervical pregnancies, all treated with the same surgical technique: suction curettage with cervical canal balloon tamponade.

CONCLUSION

Cervical pregnancy is the rarest of ectopic pregnancies. Before the now common use of early pregnancy transvaginal ultrasound, cervical pregnancies were frequently diagnosed at the time of spontaneous abortion or reached the second trimester, both associated with life-threatening hemorrhage frequently requiring hysterectomy. With early transvaginal ultrasound, especially with 3 dimensional rendering, these implantations are easily identified and can successfully be terminated with a specialized suction curettage technique.