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Köninger A, Nguyen BP, Schwenk U, Vural M, Iannaccone A, Theysohn J, Kimmig R. Cervical ectopic pregnancy - the first case of live birth and uterus-conserving management. BMC Pregnancy Childbirth 2023; 23:664. [PMID: 37715117 PMCID: PMC10504772 DOI: 10.1186/s12884-023-05951-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/24/2023] [Indexed: 09/17/2023] Open
Abstract
A 37-old III gravida II para with two previous cesarean sections (CS) presented in 7 + 3 weeks of pregnancy with cervical ectopic pregnancy (CEP). At 12th week of pregnancy, a cerclage was performed to avoid cervical distention by the expanding placenta. Due to missing experience in CEP management and to avoid emergency operation, we recommended CS in 30th week of pregnancy due to unspecific pain of the patient. Vaginal bleeding never occured.After transverse laparotomy, the urinary bladder was sharply dissected from the anterior uterine and cervical wall. The baby was delivered by transverse cervicotomy caudally of the placenta. The placenta was left in situ. The patient then got prophylactic embolization of the uterine arteries to prevent further severe hemorrhage. 48 h later, ultrasound showed a floating, avascular placenta within a poor echogenic fluid-filled cervical space as well as macrohematuria. After re-laparotomy and cervicotomy at the same day, the placenta was completely and easily evacuated. A bladder injury was recognized and closed. We performed a cervical internal os plasty by inverting the cervical lips and suturing their distal ends on the proximal cervical tissue, resulting in complete bleeding cessation. Although, the patient got 8 erythrocyte concentrates at all, she was always in a stable condition without hemorrhagic shock.This case demonstrates for the first time a live-birth with uterus-conserving management in CEP.
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Affiliation(s)
- Angela Köninger
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany.
- Department of Gynecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstrasse 1-3, 93049, Regensburg, Germany.
| | - Buu-Phuc Nguyen
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Udo Schwenk
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Mehmet Vural
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
- Department of Gynecology and Obstetrics, Hospital St. Hedwig of the Order of St. John, University of Regensburg, Steinmetzstrasse 1-3, 93049, Regensburg, Germany
| | - Antonella Iannaccone
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Jens Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
| | - Rainer Kimmig
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, Essen, 45147, Germany
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Yeh CY, Su JW, Yin-Yi Chang C, Yang CY, Lin WC, Huang CC. Cervical pregnancy: a case report of hysteroscopic resection and balloon compression combined with systematic methotrexate treatment. Taiwan J Obstet Gynecol 2022; 61:1061-1064. [DOI: 10.1016/j.tjog.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/24/2022] Open
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Li W, Gan X, Kashyap N, Zou L, Zhang A, Xu D. Comparison of high-intensity focused ultrasound ablation and uterine artery embolization in the management of cervical pregnancy. Front Med (Lausanne) 2022; 9:990066. [PMID: 36186779 PMCID: PMC9522970 DOI: 10.3389/fmed.2022.990066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Waixing Li
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Gan
- Department of Obstetrics and Gynecology, Pingxiang Maternal and Child Health Care Hospital, Pingxiang, China
| | - Nidhi Kashyap
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lingxiao Zou
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Aiqian Zhang
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
- Aiqian Zhang
| | - Dabao Xu
- Department of Obstetrics and Gynecology, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Dabao Xu
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Di Lorenzo G, Mirenda G, Springer S, Mirandola MT, Mangino FP, Romano F, Ricci G. Hysteroscopic Treatment of Cervical Pregnancy: A Scoping Review of the Literature. J Minim Invasive Gynecol 2021; 29:345-354.e1. [PMID: 34600146 DOI: 10.1016/j.jmig.2021.09.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Many therapies have been proposed for cervical pregnancy (CP) treatment; however, there is no consensus on the best practice to adopt, mainly owing to the rarity of this condition and the lack of randomized controlled trials. Therefore, there are no clinical practice guidelines for the management of this patient set. We presented an English literature review about the hysteroscopic management of CP. DATA SOURCES The literature review was performed according to the Preferred Reporting Items for Scoping Reviews. The search strategy aimed at identifying cases from the first patients tracked down to those diagnosed in May of 2021. We searched in PubMed, Scopus, Google Scholar, and MEDLINE databases. Mesh terms used included "Cervical Pregnancy," "Hysteroscopy," "Ectopic pregnancy," and "Resectoscopy." METHOD OF STUDY SELECTION Case reports of randomized controlled trials, prospective controlled studies, prospective cohort studies, retrospective studies, case series, and case reports were considered eligible. Review, Letters to the Editor, and abstracts accepted at conferences were ruled out. TABULATION, INTEGRATION, AND RESULTS We found a total of 3572 articles in all analyzed databases. A total of 2480 articles viewed were duplicated and therefore ruled out. After screening and excluding nonpertinent articles, 109 were assessed for eligibility, and 19 were included in the analysis. All articles were single case reports, small case series with no criteria selection, randomization, or study planning. We classified them as follows: cases treated with 10 mm resectoscope, with or without pretreatments of previous CP hysteroscopic approach, and cases resolved with 5 mm hysteroscopy, with or without pretreatments of previous CP hysteroscopic approach. CONCLUSION The hysteroscopic method represents a feasible and safe approach to the CP treatment, although there are still some aspects to be clarified, such as the pretreatment need and the instruments' type and sizes based on the beta-subunit of human chorionic gonadotropin, pregnancy age, and dimension.
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Affiliation(s)
- Giovanni Di Lorenzo
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Via dell'Istria (Drs. Lorenzo, Mangino, Romano, and Ricci).
| | - Giuseppe Mirenda
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, (Drs. Mirenda, Springer, Mirandola, and Ricci), Italy
| | - Serena Springer
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, (Drs. Mirenda, Springer, Mirandola, and Ricci), Italy
| | - Maria Teresa Mirandola
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, (Drs. Mirenda, Springer, Mirandola, and Ricci), Italy
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Via dell'Istria (Drs. Lorenzo, Mangino, Romano, and Ricci)
| | - Federico Romano
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Via dell'Istria (Drs. Lorenzo, Mangino, Romano, and Ricci)
| | - Giuseppe Ricci
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Via dell'Istria (Drs. Lorenzo, Mangino, Romano, and Ricci); Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, (Drs. Mirenda, Springer, Mirandola, and Ricci), Italy
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Majumdar A, Shekhar B, Satwik A. Uterin artery embolisation: a rescuer in cervical ectopic pregnancy. BMJ Case Rep 2021; 14:e244623. [PMID: 34518187 PMCID: PMC8438849 DOI: 10.1136/bcr-2021-244623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2021] [Indexed: 11/04/2022] Open
Abstract
Cervical ectopic pregnancy is an extremely rare form of ectopic pregnancy with potential risk of massive bleeding and associated morbidity. Managing this condition is challenging for clinicians due to the serious risk to patient and dilemma faced in deciding the appropriate management plan. This case report describes the role of uterine artery embolisation in managing a case of cervical ectopic pregnancy with heavy bleeding per vaginum post methotrexate treatment with falling beta human chorionic gonadotropin (HCG) levels. It highlights the unpredictable nature of this condition and need for prompt intervention in an emergency situation.
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Affiliation(s)
- Abha Majumdar
- Centre of IVF and Human Reproduction, Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Bhawani Shekhar
- Centre of IVF and Human Reproduction, Department of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Ambarish Satwik
- Vascular and Endovascular Surgery, Sir Ganga Ram Hospital, Delhi, New Delhi, India
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Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease. ACTA ACUST UNITED AC 2021; 57:medicina57050411. [PMID: 33922785 PMCID: PMC8146286 DOI: 10.3390/medicina57050411] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/12/2021] [Accepted: 04/22/2021] [Indexed: 11/22/2022]
Abstract
Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy which represents a consequence of a previous cesarean section. It is associated with major maternal morbidity and mortality and has potential implications on future fertility. Because of possible serious complications, CSP should be swiftly diagnosed and treated. There is no management protocol for this rare, life-threatening condition, and each patient should be evaluated individually. Several types of conservative treatment have been used to treat cesarean scar pregnancy: dilation and curettage (D&C), excision of trophoblastic tissues, local or systemic administration of methotrexate, bilateral hypogastric artery ligation, and selective uterine artery embolization with curettage and/or methotrexate administration. In our study we present a cesarean scar pregnancy of a 40-year-old woman who was treated with angiographic uterine artery embolization (UAE) followed by hysteroscopic diode laser resection. Our combined UAE–hysteroscopic laser surgery appears to offer an effective, safe, and minimally invasive surgical treatment.
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Stabile G, Mangino FP, Romano F, Zinicola G, Ricci G. Ectopic Cervical Pregnancy: Treatment Route. ACTA ACUST UNITED AC 2020; 56:medicina56060293. [PMID: 32545627 PMCID: PMC7353881 DOI: 10.3390/medicina56060293] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 01/24/2023]
Abstract
Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Results: In one patient treated by hysteroscopy alone it occurred a profuse vaginal bleeding with necessity for blood transfusion. Haemorrhage was controlled by a second hysteroscopic procedure. No complications, such as vaginal bleeding, were recorded in the other cases. Serum β-hCG levels become undetectable in a range of 15–40 days after hysteroscopic management; after medical treatment it become undetectable after 35 days. Serum βhCG levels had a faster drop the day after hysteroscopy than post medical management. The onset of a spontaneous pregnancy at the normal implantation site occurred after five months in one case treated by hysteroscopy. Conclusions: Many therapeutic approaches are effective for CP treatment. Hysteroscopy, alone or in combination with MTX, may provide a greater effect on the descent of βhCG, leading to a reduction of the hospitalization stay, decreasing costs and period for attempt pregnancy. Further prospective studies on larger samples are needed to define therapeutic protocols for CP management.
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Affiliation(s)
- Guglielmo Stabile
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy; (F.P.M.); (F.R.); (G.R.)
- Correspondence:
| | - Francesco Paolo Mangino
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy; (F.P.M.); (F.R.); (G.R.)
| | - Federico Romano
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy; (F.P.M.); (F.R.); (G.R.)
| | - Giulia Zinicola
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
| | - Giuseppe Ricci
- Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, 34100 Trieste, Italy; (F.P.M.); (F.R.); (G.R.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy;
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Cagle-Colon KJ, Sze A, Tsai M. Multimodal Therapy as an Effective and Bloodless Treatment for Cervical Pregnancy. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kayla J. Cagle-Colon
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
| | - Angelica Sze
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
- NYU Langone Health/Bellevue Hospital Center, New York, New York
| | - Ming Tsai
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York
- NYU Langone Health/Bellevue Hospital Center, New York, New York
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Bolaños-Bravo HH, Ricaurte-Fajardo A, Zarama-Márquez F, Ricaurte-Sossa A, Fajardo-Rivera R, Chicaiza-Maya R, Guerrero-Mejía CA. Conservative management in a patient with cervical ectopic pregnancy in Nariño, Colombia: Case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:277-292. [PMID: 32142242 DOI: 10.18597/rcog.3357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 01/21/2020] [Indexed: 12/17/2022]
Abstract
Objectives To report a case of cervical pregnancy (CP) treated successfully with a conservative approach, and to conduct a review of the literature regarding conservative medical and surgical treatment. Materials and methods Patient with cervical pregnancy treated pharmacologically with methotrexate (MTX) followed by dilation and curettage, with a satisfactory clinical course. A search of articles was conducted in Medline via PubMed, LILACS, SciElo and Google Scholar using the terms "cervical ectopic pregnancy," "conservative treatment," "curettage,» "methotrexate," "uterine artery embolization," "hysteroscopy." Reports and case series were selected of patients with cervical pregnancy diagnosed on ultrasound at any gestational age, subjected to conservative medical or surgical treatment. Results A total of 22 studies were included; 95 patients with CP treated with MTX were identified, 93 of them successfully treated. The most frequent complication was bleeding in 12%; 26% required complementary surgical treatment. Increasingly, uterine artery embolization (UAE) is carried out preventatively (7 cases) before curettage or treatment with MTX. The hysteroscopy is another recent alternative (20 cases). Abdominal hysterectomy was required in two cases, one of which was a cervico-isthmic pregnancy. Conclusions Treatment with MTX continues to be the most frequent strategy. Dilation and curettage with endocervical plugging may be an option to consider in the emergency management of EP in primary care institutions. In institutions equipped with high complexity technology, uterine artery embolization before the surgical procedure and histeroscopy are options to be considered. Considering that early diagnosis of EP is now possible, multi-center studies comparing different management options are needed for better assessment of their safety and effectiveness.
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Affiliation(s)
- Henry Hernán Bolaños-Bravo
- Departamento de Ginecología y Obstetricia, Hospital Universitario Departamental de Nariño, San Juan de Pasto (Colombia)
| | | | - Fabio Zarama-Márquez
- Departamento de Ginecología y Obstetricia, Hospital Universitario Departamental de Nariño, San Juan de Pasto (Colombia)
| | - Andrés Ricaurte-Sossa
- Departamento de Ginecología y Obstetricia, Hospital Universitario Departamental de Nariño, San Juan de Pasto (Colombia)
| | - Ruth Fajardo-Rivera
- Hospital Universitario Departamental de Nariño, Universidad Cooperativa de Colombia, San Juan de Pasto (Colombia)
| | - Rubén Chicaiza-Maya
- Hospital Universitario Departamental de Nariño, Universidad Cooperativa de Colombia, San Juan de Pasto (Colombia)
| | - Carlos Andrés Guerrero-Mejía
- Hospital Universitario Departamental de Nariño, Fundación Universitaria San Martín, San Juan de Pasto (Colombia)
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Hysteroscopic management of cervical pregnancy: Case series and review of the literature. J Gynecol Obstet Hum Reprod 2019; 48:247-253. [DOI: 10.1016/j.jogoh.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/27/2018] [Accepted: 05/02/2018] [Indexed: 11/23/2022]
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Iannone P, Nencini G, Bonaccorsi G, Martinello R, Pontrelli G, Scioscia M, Nappi L, Greco P, Scutiero G. Isthmocele: From Risk Factors to Management. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2019; 41:44-52. [PMID: 30646424 PMCID: PMC10416161 DOI: 10.1055/s-0038-1676109] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of the present study was to perform a comprehensive review of the literature to provide a complete and clear picture of isthmocele-a hypoechoic area within the myometrium at the site of the uterine scar of a previous cesarean section-by exploring in depth every aspect of this condition. METHODS A comprehensive review of the literature was performed to identify the most relevant studies about this topic. RESULTS Every aspect of isthmocele has been studied and described: pathophysiology, clinical symptoms, classification, and diagnosis. Its treatment, both medical and surgical, has also been reported according to the actual literature data. CONCLUSION Cesarean section is the most common surgical procedure performed worldwide, and one of the consequences of this technique is isthmocele. A single and systematic classification of isthmocele is needed to improve its diagnosis and management. Further studies should be performed to better understand its pathogenesis.
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Affiliation(s)
- Piergiorgio Iannone
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
| | - Giulia Nencini
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
| | - Gloria Bonaccorsi
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
| | - Ruby Martinello
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
| | - Giovanni Pontrelli
- Section of Obstetrics and Gynaecology, Policlinico di Abano Terme, Abano Terme, Padova, Italy
| | - Marco Scioscia
- Section of Obstetrics and Gynaecology, Policlinico di Abano Terme, Abano Terme, Padova, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Pantaleo Greco
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
| | - Gennaro Scutiero
- Section of Obstetrics and Gynecology, Department of Morphology, Surgery and Experimental Medicine, Azienda Ospedaliero-Universitaria S. Anna, Università di Ferrara, Cona, Ferrara, Italy
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Hu J, Tao X, Yin L, Shi Y. Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases. BJOG 2018; 123 Suppl 3:97-102. [PMID: 27627607 DOI: 10.1111/1471-0528.14005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE 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. DESIGN Retrospective review. SETTING Peking University First Hospital. SAMPLE Patients with cervical pregnancy diagnosed by trans-vaginal ultrasound at Peking University First Hospital between January 2003 and December 2014. METHODS 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. MAIN OUTCOME MEASURES 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. RESULTS A total of 19 patients with cervical pregnancy treated with UAE followed by curettage were identified. Curettage was performed 24-72 hours after UAE in 16 patients, within 24 hours 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 59 months), 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. CONCLUSION UAE combined with curettage is a safe, effective and fertility-sparing choice for treatment of patients with cervical pregnancy. TWEETABLE ABSTRACT A serial of 19 patients with cervical pregnancy treated with UAE followed by curettage showed a good prognosis.
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Affiliation(s)
- J Hu
- Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China
| | - X Tao
- Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China.
| | - L Yin
- Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China
| | - Y Shi
- Department of Obstetrics and Gynaecology, Peking University First Hospital, Beijing, China
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Successful Management of Cervical Ectopic Pregnancy with Bilateral Uterine Artery Embolization and Methotrexate. Case Rep Emerg Med 2018; 2018:9593824. [PMID: 29854485 PMCID: PMC5960537 DOI: 10.1155/2018/9593824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/26/2018] [Indexed: 11/20/2022] Open
Abstract
Cervical ectopic pregnancy (CEP) is a rare form of ectopic pregnancy. Cases diagnosed early in pregnancy can be managed medically, but more advanced pregnancies often require hysterectomy. Uterine artery embolization (UAE) is a novel approach to CEP for those who wish to preserve fertility. Here we present the case of a 44-year-old female with a 2-week history of vaginal bleeding and abdominal pain who was diagnosed with CEP and successfully treated with bilateral UAE (BUAE) in combination with methotrexate. A 44-year-old female presented to the emergency department with a 2-week history of vaginal bleeding. Serum beta-hCG was 71,964 mIU/ml. The transvaginal ultrasound confirmed CEP. The patient was referred to obstetrics and interventional radiology and ultimately treated with BUAE and methotrexate. Symptoms resolved quickly and she was discharged after 3 days.
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Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J OBSTET GYNAECOL 2017. [PMID: 28631522 DOI: 10.1080/01443615.2017.1323852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.
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Affiliation(s)
- Aderemi Olaoluwa Alalade
- a Department of Obstetrics and Gynaecology , Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board , Wrexham , UK
| | - Fredrick John Ennis Smith
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Charlotte Emma Kendall
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Funlayo Odejinmi
- c Department of Obstetrics and Gynaecology, Barts Health NHS Trust , Whipps Cross University Hospital , London , England
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Abstract
IMPORTANCE Cervical pregnancy is a rare variety of ectopic pregnancy. The etiology is obscure. Its diagnosis may be difficult, and its management has enormously changed during the last 10 years. Unfortunately, the most effective, fertility-sparing treatment is still unclear until now. OBJECTIVES The aim of this study was to explore the safety and efficacy of different treatment modalities of cervical pregnancy. EVIDENCE ACQUISITION A comprehensive systematic review of the literature was performed using the electronic databases MEDLINE and PubMed, using key words cervical, ectopic, and pregnancy, between January 2005 and June 2013. We included all case reports and case series reporting on cervical ectopic pregnancy. RESULTS A total of 252 cases of cervical ectopic pregnancy were analyzed. Eighty-eight cases (34.9%) had medical treatment, 69 cases (27.5%) had surgical treatment, and 95 cases (37.6%) had combined medical and surgical treatment. Various conservative treatment regimens have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used and effective drugs. CONCLUSIONS AND RELEVANCE A high index of suspicion, combined with meticulous review of clinical and radiological findings, is essential to make an accurate diagnosis of cervical pregnancy. The success of conservative treatment depends mainly on early diagnosis. Such cases would be best managed at specialist tertiary referral centers and preferably, where available, Early Pregnancy Assessment Units, whether medical, surgical, or combined treatment modalities were attempted.
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