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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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Zhu Q, Tang Y, Tian Q, Cheng H, Yang J, Xiong L, Li W, Zou L, Cheng W, Luo X. Clinical efficacy and safety analysis of different treatment options for Cervical pregnancy. Int J Hyperthermia 2023; 40:2255757. [PMID: 37699591 DOI: 10.1080/02656736.2023.2255757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of different treatment options for cervical pregnancy (CP). MATERIALS AND METHODS A total of 74 patients diagnosed with CP at Hunan Provincial Maternal and Child Health Care Hospital between January 2016 and September 2022 were retrospectively analyzed. Among them, 31 were treated with uterine artery embolization (UAE) followed by hysteroscopic curettage, 34 were treated with hysteroscopic curettage alone, and nine were treated with high-intensity focused ultrasound (HIFU) followed by hysteroscopic curettage. Medical records and pregnancy outcomes were analyzed. RESULTS There were no significant differences in age, gravidity, parity, abortion, or preoperative hemoglobin levels among the patients in the three groups; however, significant differences in gestational age, gestational sac diameter, preoperative β-hCG, and presence of cardiac pulsation were observed (p < 0.05). After treatment, there was no conversion to laparotomy, and the uterus was preserved in all patients. Significant differences in blood loss during curettage, hospitalization costs, hospital days, menstrual recovery interval, β-hCG decline rates, retained products of conception, and intrauterine adhesions rate among the three groups were observed (p < 0.05). There were no significant differences in the placement of the uterine Foley balloon, effective curettage rate, pre-and postoperative hemoglobin decline, live birth rate, or proportion of subsequent pregnancies among the three groups. CONCLUSION Our results showed that hysteroscopic curettage, HIFU, and UAE followed by hysteroscopic curettage are safe and effective for treating patients with CP. Compared with the UAE, HIFU has the advantages of lower hospitalization costs, shorter hospital stays, and shorter menstrual recovery intervals.
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Affiliation(s)
- Qiaoling Zhu
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Yi Tang
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Qi Tian
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Hui Cheng
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Li Xiong
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Wei Li
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Lingzhi Zou
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Wei Cheng
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
| | - Xiaomei Luo
- Department of Obstetrics and Gynecology, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, P.R. China
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Abstract
Background: Cervical ectopic pregnancy is a rare condition, historically treated by hysterectomy. Case Report: A 33-year-old female at 13 weeks 3 days’ gestation was diagnosed with a cervical ectopic pregnancy. She underwent a uterine artery embolization, fetal intrathoracic potassium chloride injection, amniocentesis, and ultrasound-guided suction dilation and curettage with the use of intracervical vasopressin, flowable gelatin with thrombin, and cervical cerclage. Conclusion: Advanced cervical ectopic pregnancy can be successfully managed in a conservative fashion in a patient who strongly desires future fertility.
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Methotrexate infusion followed by uterine artery embolisation for the management of placental adhesive disorders: a case series. Clin Radiol 2019; 74:378-383. [DOI: 10.1016/j.crad.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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Juusela AL, Gimovsky ML. Intraoperative Hemorrhage Requiring Emergent Hysterectomy: Failed Conservative Management of a Cervical Placenta Accreta. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tamhane N, Parikh A, Joshi VM. Placenta increta complicating a second trimester cervical pregnancy: a case report. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2017-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Cervical ectopic pregnancy is defined as implantation of the embryo in the endocervical canal below the level of the internal os. It is a rare condition that accounts for 0.15% of all ectopic pregnancies. As it can lead to complications such as uncontrolled hemorrhage, it is associated with high morbidity and mortality. This paper illustrates a rare case of a 2nd trimester cervical pregnancy with failed conservative management due to the limitations of ultrasonography. Successful conservative management requires not only early diagnosis but also usage of other sophisticated techniques such as magnetic resonance imaging (MRI) that can help in detecting adherent placenta.
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Farasatinasab M, Moghaddas A, Dashti-Khadivaki S, Raoofi Z, Nasiripour S. Management of Abnormal Placenta Implantation with Methotrexate: A Review of Published Data. Gynecol Obstet Invest 2016; 81:481-496. [PMID: 27384687 DOI: 10.1159/000447556] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/13/2016] [Indexed: 04/13/2024]
Abstract
Abnormally invasive placenta is characterized by direct attachment of chorionic villi to the uterine wall. This adherent placenta traditionally has been managed by peripartum hysterectomy. Nowadays, there is a lot of interest toward gradual shift from traditional management of invasive placentation to conservative ones leaving the placenta in situ to avoid the surgical morbidity of hysterectomy and loss of future fertility. Administration of methotrexate (MTX), as an adjunctive antimetabolite drug, resulted in conflicting data during conservative management of abnormal placentation. This review assessed all published data on efficacy and safety of MTX therapy as conservative management of invasive placentation. Fifty-three articles including one prospective cohort study, 2 retrospective cohort studies, 10 case series and 40 case reports were identified. Conservative management has beneficial effects on the avoidance of major surgery with the consequent morbidity and the preservation of future fertility. Infection and vaginal bleeding were main complications of MTX therapy. Although MTX therapy may result in accelerated involution or expulsion of placenta and has some beneficial effects on hemorrhagic events, but there is not enough evidence on its efficacy and safety to recommend its routine uses in all cases of invasive placenta.
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Affiliation(s)
- Maryam Farasatinasab
- Department of Clinical Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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Cervicoisthmic pregnancy near cesarean scar after oocyte donation in premature ovarian failure: literature review starting from a single case. J Low Genit Tract Dis 2013; 18:E4-11. [PMID: 23959295 DOI: 10.1097/lgt.0b013e3182893dbc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to identify the best management options in decision making in cases of cervicoisthmic and cesarean scar pregnancies and rare forms of ectopic pregnancies with high rates of pregnancy-related morbidity in the first trimester, more commonly associated with assisted reproductive medicine. MATERIALS AND METHODS We performed a literature review of the description of a case report of a cervicoisthmic pregnancy near a cesarean scar in a premature ovarian failure woman. She obtained pregnancy after ovum donation, hormonal therapy, and in vitro fertilization. The researchers focused on the MEDLINE/PubMed database articles on ectopic pregnancies, particularly on cesarean scar pregnancies, cervical pregnancies, and ectopic pregnancies after in vitro fertilization in English-language journals published from January 1996 to December 2011. RESULTS The conservative or nonconservative options for medical or surgical treatments are disposables. Moreover, in literature, no consensus was found about the best treatment method. CONCLUSIONS Obstetricians should pay great attention to a possible cesarean scar pregnancy in patients with risk factors in their medical history. Until now, the rarity of these findings does not allow the definition of a commonly accepted management, so the best personalized approach may be guided by early recognition, close surveillance, and appropriate counseling. Further investigations are necessary to recognize high-risk factors for all ectopic pregnancies and those unique to cesarean scar ectopic pregnancies.
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Acute hemorrhage related to a residual cervical pregnancy: management with curettage, tamponade, and cerclage. J Minim Invasive Gynecol 2013; 20:907-11. [PMID: 23876387 DOI: 10.1016/j.jmig.2013.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 05/10/2013] [Accepted: 05/12/2013] [Indexed: 12/14/2022]
Abstract
Cervical ectopic pregnancy is uncommon, with no universally accepted protocol for conservative management of acute hemorrhage due to residual cervical ectopic pregnancy. Herein is presented the case of a 33-year-old woman with profuse vaginal bleeding 3 months after receiving treatment including intraamniotic potassium chloride injection, systemic methotrexate, and uterine artery embolization because of a cervical ectopic pregnancy. A residual cervical pregnancy was suspected. Hemorrhage was controlled using curettage, tamponade with a Bakri balloon, and cerclage. The balloon and cerclage were removed on postoperative day 2, with no recurrence of symptoms. Our experience suggests that a combination of curettage, balloon tamponade, and cerclage may be considered in the management of cervical ectopic pregnancies with acute hemorrhage, in particular in patients desiring future childbearing.
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English D, Verma U, Yasin S. Conservative management of a 20-week cervical ectopic pregnancy with placenta percreta. Arch Gynecol Obstet 2012; 288:225-8. [PMID: 23263170 DOI: 10.1007/s00404-012-2654-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/20/2012] [Indexed: 10/27/2022]
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Hafner T, Ivkosic IE, Serman A, Bauman R, Ujevic B, Vujisic S, Hafner D, Miskovic B. Modification of conservative treatment of heterotopic cervical pregnancy by Foley catheter balloon fixation with cerclage sutures at the level of the external cervical os: a case report. J Med Case Rep 2010; 4:212. [PMID: 20637109 PMCID: PMC2911469 DOI: 10.1186/1752-1947-4-212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Accepted: 07/16/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction Conservative treatment of a heterotopic cervical pregnancy was performed with a modification of the fixation of a Foley catheter at the level of the external cervical os, followed by the ligature of the descending cervical branches of the uterine arteries and systemic methotrexate application. Case presentation A 34-year-old Caucasian woman was diagnosed with double gestation after 6 weeks of in vitro fertilization treatment. A gynecological examination and color Doppler ultrasound scan revealed intra-uterine and cervical gestational sacs both containing live fetuses. A Foley catheter balloon was inserted into the cervical canal, inflated and fixed by a cerclage suture at the level of the external cervical os, followed by ligation of the descending cervical branches of the uterine arteries. Systemic methotrexate was applied. Three days after removal of the Foley catheter, an evacuation of the intra-uterine gestational sac was performed. Hemorrhage from the implantation site was controlled immediately and a pregnancy termination was successfully performed. The procedure was uneventful and our patient was discharged with a preserved uterus. Conclusions Conservative treatment of cervical pregnancy using a Foley catheter balloon is more efficacious if the Foley catheter balloon is attached in the correct position with a cerclage suture at the level of the external os, followed by ligation of the descending cervical branches of the uterine arteries, thereby exerting maximal pressure on the bleeding vessels.
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Affiliation(s)
- Tomislav Hafner
- Department of Obstetrics and Gynaecology, Clinical Hospital Sveti Duh, Zagreb, Croatia.
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Su WH, Cheng MH, Tsou TS, Cheung SM, Chang SP, Wang PH. Port wound closure assisted by Foley catheter: An easier way to provide fascia security. J Obstet Gynaecol Res 2009; 35:725-31. [DOI: 10.1111/j.1447-0756.2008.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Successful Conservative Management of Placenta Previa Totalis and Extensive Percreta. Taiwan J Obstet Gynecol 2008; 47:431-4. [DOI: 10.1016/s1028-4559(09)60011-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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