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Tremmel E, Starrach T, Buschmann C, Trillsch F, Kolben T, Mahner S, Burges A, Kost B, Ehmann L, Burgmann DM. Management of non-tubal ectopic pregnancies analysis of a large tertiary center case series. Arch Gynecol Obstet 2024; 309:1227-1236. [PMID: 38078931 PMCID: PMC10894165 DOI: 10.1007/s00404-023-07290-4] [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: 07/08/2023] [Accepted: 11/06/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Ectopic pregnancies include cesarean scar (CSP), cornual and cervical pregnancies. Various treatment modalities have been- described, but no standardized procedure has been defined so far. The aim of our analysis was to evaluate the diagnostics and treatment at the Department of Obstetrics and Gynecology, LMU University Hospital, Munich. METHODS In this retrospective, single-center analysis, 24 patients treated between 2015 and 2020 were analyzed. After verification of the diagnosis by imaging and HCG-analysis, the treatment was individually determined: therapy with methotrexate (MTX) locally with or without simultaneous systemic treatment, surgical treatment via curettage, excision with uterine reconstruction even hemi hysterectomy. RESULTS Ten patients presented with CSP, six with cervical and eight with cornual pregnancies. Median age was 34.6 years. CSP was treated with local MTX in six cases; five required additional treatment with systemic MTX or curettage. Primary curettage or surgery was performed in four cases. In cervical pregnancies the primary therapy with local MTX injection and systemic treatment was performed in 50%. One patient was treated with MTX and insertion of a Bakri balloon. Trachelectomy was required in one case. 50% of cornual pregnancies were treated with MTX locally and intramuscularly and 50% received surgery. CONCLUSION Treatment strategies were based on the patient's individual risk parameters. The results of this study show, that simultaneous treatment with local and systemic MTX had good outcomes and could avoid surgeries.
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Affiliation(s)
- E Tremmel
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - T Starrach
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - C Buschmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - F Trillsch
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - T Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - A Burges
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - B Kost
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - L Ehmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - D M Burgmann
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Di Carlofelice M, Vress D. Neo-adjuvant methotrexate to aid minimally invasive surgery in cervical ectopic pregnancy: A case report. Case Rep Womens Health 2024; 41:e00593. [PMID: 38487376 PMCID: PMC10937223 DOI: 10.1016/j.crwh.2024.e00593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024] Open
Abstract
Cervical ectopic pregnancies account for <1% of ectopic pregnancies. Early diagnosis may reduce the morbidity and mortality associated with treatment. A 43-year-old woman, gravida 4 para 2, presented at 5 + 6 weeks of gestation of pregnancy via in vitro fertilisation with painless vaginal bleeding. Her initial serum β-hCG level was 51,495 mIU/mL. Ultrasound showed a live ectopic pregnancy within the upper cervical canal with no sliding sign. Surgery was avoided initially due to risk of haemorrhage. Multi-dose systemic intramuscular methotrexate was used in an alternate-day regimen with rescue folic acid to arrest further pregnancy development. Repeat ultrasound seven days later showed absent cardiac activity. Serum β-hCG remained high at 91,764 mIU/mL. A suction dilatation and curettage was performed to remove the pregnancy from the cervix, with an estimated blood loss of 50 mL. The patient was discharged and her serum β-hCG declined to an undetectable level over three months of follow-up. This case adds to the small body of evidence in the management of live cervical ectopic pregnancy. Neo-adjuvant multi-dose methotrexate was successfully used to reduce the risk of haemorrhage associated with surgical management.
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Affiliation(s)
- Matteo Di Carlofelice
- Department of Obstetrics & Gynaecology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory 2605, Australia
| | - Danica Vress
- Department of Obstetrics & Gynaecology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory 2605, Australia
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Nikolettos K, Oikonomou E, Kotanidou S, Kritsotaki N, Kyriakou D, Tsikouras P, Kontomanolis E, Gerede A, Nikolettos N. A Systematic Review about Cervical Pregnancy and our Experience. Acta Med Litu 2024; 31:92-101. [PMID: 38978851 PMCID: PMC11227684 DOI: 10.15388/amed.2024.31.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 07/10/2024] Open
Abstract
Background Cervical ectopic pregnancy is a relatively rare type of ectopic pregnancy and has no standardized guidelines for management. Methods This systematic review is based on the collection of case reports, published in PubMed/MEDLINE about the resolution of ectopic cervical pregnancies over the last decade and the presentation of a case managed in our healthcare unit. Studies involving cervical pregnancy in the first trimester with the presence of a viable embryo and β-hCG in the serum below 100.000 mIU/mL were included, while heterotopic pregnancies were excluded. Results Nineteen articles reporting twenty-three case reports are demonstrated explicitly emphasizing on the management techniques. There is no established approach for the management of this type of ectopic pregnancy. Conclusion It is important to consider the conservative approaches as first-line treatment in all cases of cervical pregnancy preserving fertility. Minimally invasive methods are also described and preferred as second-line treatment, as reported in our literature review.
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Affiliation(s)
- Konstantinos Nikolettos
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Efthymios Oikonomou
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Sonia Kotanidou
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nektaria Kritsotaki
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitrios Kyriakou
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Panagiotis Tsikouras
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Emmanouil Kontomanolis
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Angeliki Gerede
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikos Nikolettos
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Valdés-Martínez OH, Sordia-Hernández LH, Sordia-Piñeyro MO, Guerra-Leal JD, García-Luna SM, Morales-Martínez FA. Intrasaccular methotrexate treatment of cervical pregnancies maintains fertility: a case series. J OBSTET GYNAECOL 2023; 43:2130207. [PMID: 36240120 DOI: 10.1080/01443615.2022.2130207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Otto Hugo Valdés-Martínez
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Luis Humberto Sordia-Hernández
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - María Ofelia Sordia-Piñeyro
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Jesús Dante Guerra-Leal
- Centro Universitario de Imagen Diagnostica, Departamento de Radiología e Imagen, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González". Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Selene M García-Luna
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
| | - Felipe Arturo Morales-Martínez
- Centro Universitario de Medicina Reproductiva, Departamento de Ginecología y Obstetricia, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, N.L., México
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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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Mori KH, Tavares BV, Yela DA, Baccaro LFC, Juliato CRT. Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:1014-1020. [PMID: 36580946 PMCID: PMC9800062 DOI: 10.1055/s-0042-1757954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cervical pregnancy is challenging for the medical community, as it is potentially fatal. The treatment can be medical or surgical; however, there are no protocols that establish the best option for each case. The objective of the present study was to describe the cases of cervical pregnancy admitted to a tertiary university hospital over a period of 18 years. METHODS A retrospective study based on a review of the medical records of all cervical pregnancies admitted to the Women's Hospital at Universidade Estadual de Campinas, Southeastern Brazil, from 2000 to 2018. RESULTS We identified 13 cases of cervical pregnancy out of a total of 673 ectopic pregnancies; only 1 case was initially treated with surgery because of hemodynamic instability. Of the 12 cases treated conservatively, 7 were treated with single-dose intramuscular methotrexate, 1, with intravenous and intramuscular methotrexate, 1, with intravenous methotrexate, 1, with 2 doses of intramuscular methotrexate, and 2, with intra-amniotic methotrexate. Of these cases, one had a therapeutic failure that required a hysterectomy. Two women received blood transfusions. Four women required cervical tamponade with a Foley catheter balloon for hemostasis. There was no fatal outcome. CONCLUSION Cervical pregnancy is a rare and challenging condition from diagnosis to treatment. Conservative treatment was the primary method of therapy used, with satisfactory results. In cases of increased bleeding, cervical curettage was the initial treatment, and it was associated with the use of a cervical balloon for hemostasis.
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Affiliation(s)
| | | | | | | | - Cassia Raquel Teatin Juliato
- Universidade Estadual de Campinas, Campinas, SP, Brazil,Address for correspondence Cássia Raquel Teatin Juliato Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881Brazil
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7
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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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Kovachev E, Anzhel S, Zhekov Z, Tabakova N, Dimova S. Second-Trimester Cervico-Isthmic Pregnancy after Donor Egg In Vitro Fertilization, Complicated with Placenta Accreta – Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Cervical gestations are rare potentially life-threatening conditions. Although these can cause massive hemorrhage, most of them abort during the first trimester without having been diagnosed. However, cervico-isthmic pregnancies are more likely to persist to an advanced gestation in the second and third trimester owing the need for hysterectomy due to defect placentation.
CASE PRESENTATION: We presented a rare case of cervical pregnancy after donor egg in vitro fertilization procedure, with no previous pregnancies, medical, and surgical history. Our patient rejected early termination of pregnancy at 5 gestational weeks. Pregnancy continued until 16 weeks when she was hospitalized and terminated due to medical grounds with curettage. Post-operative period was uneventful until day 20, when she was admitted with suspicion of retained placental tissue and endometritis. A hysterectomy was done with blood transfusion due to excessive blood loss. Histologic examination confirmed placenta accreta spectrum disorder.
CONCLUSION: Cervical pregnancy can be treated conservative if timely diagnosed by early ultrasound, which can reduce the chances of severe life-threatening hemorrhage necessitating hysterectomy or blood transfusion.
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Coulter-Nile S, Balachandar K, Ward H. A diagnostic dilemma of an 18-week cervical ectopic pregnancy: A case report. Case Rep Womens Health 2022; 33:e00385. [PMID: 35198413 PMCID: PMC8841278 DOI: 10.1016/j.crwh.2022.e00385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Cervical ectopic pregnancy (CEP) is characterised by the implantation of trophoblastic tissue within the cervical canal and is associated with a significant risk of maternal morbidity and mortality. This case report addresses a second-trimester CEP with unusual sonographic features suspicious of placenta accreta spectrum (PAS), which was successfully managed with an abdominal hysterectomy. Case Presentation A 27-year-old woman, G6P2, presented to the labour ward of a rural hospital at 18 weeks of gestation with premature rupture of membranes. The index pregnancy was complicated by an absence of any antenatal care, as well as a history of cigarette smoking and cannabis use. An ultrasound scan demonstrated a live pregnancy with the foetal head within the cervical canal. A termination of pregnancy was arranged with misoprostol 200 mg orally followed by an oxytocin induction. However, a repeat ultrasound scan, after 12 h of oxytocin infusion, which failed to terminate the pregnancy, demonstrated a still live foetus as well as increased vascularity, concerning for PAS. The patient underwent an emergency abdominal hysterectomy, with an intraoperative diagnosis of a CEP. The postoperative course was unremarkable, and the patient was discharged home on day 3 post-operatively. Discussion Appropriate antenatal care and early booking-in would have identified a CEP early in gestation and allowed for minimally invasive management and potential conservation of fertility. When this is not possible in such cases, meticulous pre-operative planning by a gynaecologist with experience in advanced pelvic surgery can minimise the associated morbidity and mortality. Cervical ectopic pregnancies are rare and at a late gestation can be difficult to diagnose A multigravida woman at 18 weeks gestation presented in preterm labour with ultrasound concern for placenta accreta Intraoperatively she was found to have a cervical ectopic pregnancy An abdominal hysterectomy was required in management Early antenatal care is vital in diagnosis of cervical ectopic pregnancy and can potentially conserve fertility
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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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Maglic R, Rakic A, Nikolic B, Maglic D, Jokanovic P, Mihajlovic S. Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy. JSLS 2021; 25:JSLS.2021.00016. [PMID: 34248344 PMCID: PMC8249221 DOI: 10.4293/jsls.2021.00016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background and Objectives: Cervical ectopic pregnancy is one of the rarest forms of ectopic pregnancy. We present a single center case series of 10 cases of cervical ectopic pregnancy, where 3 patients underwent small-caliber hysteroscopy as a single treatment method. Methods: This was a retrospective study of women treated at our medical center with the diagnosis of cervical ectopic pregnancy from January 1, 2018 to December 31, 2020. Patient characteristics, medical history, obstetric history, diagnostic methods were collected. Small-caliber hysteroscopy treatment was performed in 3 patients and 7 patients underwent dilation and curettage (D&C). Results: We identified 10 patients diagnosed with cervical ectopic pregnancy who were treated at our center. Ultrasonography was used to diagnose all cervical ectopic pregnancies Three patients underwent small-caliber hysteroscopy as a single treatment option, while D&C was performed in 7 patients. Patients who underwent small-caliber hysteroscopy had a median gestational age at diagnosis of 7 weeks and initial βHCG < 10,000 mIU/mL. These patients had shorter hospital stay and a lower estimated blood loss than patients who underwent D&C. Conclusions: In our experience, small-caliber hysteroscopy is a safe and effective single treatment option for cervical ectopic pregnancy, but requires a skilled and experienced gynecologist.
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Affiliation(s)
- Rastko Maglic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
| | - Aleksandar Rakic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
| | - Branka Nikolic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
| | - Dragana Maglic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
| | - Predrag Jokanovic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
| | - Sladjana Mihajlovic
- Department of Conservative Gynecology, Obstetrics and Gynecology Clinic Narodni Front, Belgrade, Serbia
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Dilday E, Douglas C, Brennan K. Single-dose intramuscular methotrexate for treatment of cervical ectopic pregnancy: A case report. Case Rep Womens Health 2021; 31:e00340. [PMID: 34336601 PMCID: PMC8313574 DOI: 10.1016/j.crwh.2021.e00340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction Cervical ectopic pregnancy (CEP) is a rare but potentially life-threatening phenomenon, and conclusive management guidelines have not been elucidated. Patients undergoing assisted reproductive technologies (ART) are at increased risk of CEP and noninvasive, fertility-sparing treatments are necessary for this population. This case report demonstrates the safety and efficacy of a single dose of intramuscular methotrexate for CEP in early gestation. Case Description A 45-year-old patient (G3P0030) presenting with painless vaginal bleeding was found to have CEP on transvaginal ultrasound at 5 weeks and 1 day of gestation after undergoing day-5 frozen embryo transfer. She was given one 50 mg/m2 dose of intramuscular methotrexate and she remained in a stable condition while being observed in the hospital. Her beta-hCG level decreased 38.2% between day 4 and day 7 after treatment and returned to nonpregnancy levels by day 28. Discussion A single dose of intramuscular methotrexate is an effective, noninvasive, fertility-sparing method of treatment for CEP in patients who are early in gestation and hemodynamically stable. This is a recommended option, especially for those undergoing fertility treatment. Further studies need to be performed to formulate national guidelines regarding the treatment of CEP. Cervical ectopic pregnancy (CEP) is rare and potentially life-threatening. Use of assisted reproductive technologies (ART) increases patients' risk of CEP. Most patients with CEP after the use of ART desire fertility-sparing treatment when possible. In the case described, single-dose methotrexate was used as a fertility-sparing treatment of CEP.
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Affiliation(s)
- Elizabeth Dilday
- University of California, Los Angeles Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles, California, 10833 Le Conte Ave CHS 27-139, Los Angeles, CA 90095, USA
| | - Christopher Douglas
- University of California, Los Angeles Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles, California, 10833 Le Conte Ave CHS 27-139, Los Angeles, CA 90095, USA
| | - Kathleen Brennan
- University of California, Los Angeles Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, David Geffen School of Medicine, Los Angeles, California, 10833 Le Conte Ave CHS 27-139, Los Angeles, CA 90095, USA
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Management of Cervical Ectopic Pregnancies: A Scoping Review. Obstet Gynecol 2021; 138:33-41. [PMID: 34259461 DOI: 10.1097/aog.0000000000004423] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate published cases of cervical ectopic pregnancy between 2000 and 2018 and compare management strategies and treatment success rates based on initial patient characteristics. METHODS PubMed, EMBASE, and Web of Science were searched to capture peer-reviewed citations published between 2000 and 2018. Cases reporting either β-hCG level, crown-rump length, or gestational sac diameter for each individual patient were included. Data regarding the article information, patient characteristics, treatment used, and outcomes were collected. Initial success was defined as resolution of the cervical ectopic pregnancy with the predefined treatment plan. Initial failure was defined as the requirement of additional unplanned interventions due to the predefined treatment plan not being successful. End success was defined as resolution of the cervical ectopic pregnancy without hysterectomy. RESULTS A total of 204 articles from 44 countries comprising 454 cases were reviewed. The initial β-hCG level ranged from 9 to 286,500, with a median of 14,773, and gestational age ranged from 4 to 18 weeks, with an average of 7 4/7 weeks (±2 0/7 weeks). In looking at initial success, compared with methotrexate alone, dilation, and curettage (odds ratio [OR] 2.26; 95% CI 2.64-10.45), dilation and curettage combined with uterine artery embolization (OR 4.85; 95% CI 2.06-11.44) and uterine artery embolization (OR 5.17; 95% CI 1.14-23.53) were more effective options. More than half of patients (50.2%) required multiple interventions, and 41 (9%) resulted in hysterectomy. CONCLUSIONS Management of cervical ectopic pregnancies should be guided by patient stability, β-hCG level, size of pregnancy, and fetal cardiac activity but may benefit from a planned multimodal approach.
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Han JY, Kim H, Kim SW, Ku SY, Suh CS, Kim SH. Use of haemostatic gel in the management of cervical pregnancy: a case report. EUR J CONTRACEP REPR 2020; 26:167-170. [PMID: 33021850 DOI: 10.1080/13625187.2020.1824270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE This case report aimed to describe haemostatic agents with systemic methotrexate (MTX) as an effective management for cervical pregnancy with bleeding. CASE PRESENTATION A 34-year-old nulligravida patient was referred due to vaginal spotting and lower abdominal discomfort, and was diagnosed with a cervical pregnancy at 6 weeks of gestation. The patient was treated with a multi-dose MTX regimen, and the bleeding was successfully controlled with haemostatic agents, which were applied at the bleeding site of the cervix. After completion of MTX treatment, beta human chorionic gonadotropin (β-hCG) decreased to undetectable range. Furthermore, patients could preserve her uterus and maintain fertility. CONCLUSION Haemostatic agents can be regarded as an effective option for vaginal bleeding due to cervical pregnancy.
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Affiliation(s)
- Ji Yeon Han
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hoon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yup Ku
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Suk Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seok Hyun Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Reproductive outcomes of cesarean scar pregnancies pretreated with methotrexate and uterine artery embolization prior to curettage. Taiwan J Obstet Gynecol 2020; 59:381-386. [DOI: 10.1016/j.tjog.2020.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
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17
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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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A case report of a misdiagnosed cesarean scar pregnancy in a hemodynamically compromised patient. HUMAN PATHOLOGY: CASE REPORTS 2019. [DOI: 10.1016/j.ehpc.2019.200344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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20
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Rubattu A, Corda V, Derosas I, Monni MC, Nocco C, Iuculano A, Peppi G, Rosas N, Ruiu G, Monni G. Successful hysteroscopic treatment of a cervical heterotopic pregnancy: case report and literature review. J OBSTET GYNAECOL 2019; 40:580-581. [PMID: 31385728 DOI: 10.1080/01443615.2019.1607269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Antonio Rubattu
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Valentina Corda
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari, Italy
| | - Iside Derosas
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Maria Carla Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari, Italy
| | - Cristina Nocco
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Ambra Iuculano
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari, Italy
| | - Giangavino Peppi
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Nadia Rosas
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Giovanni Ruiu
- Department of Obstetrics and Gynecology, Giovanni Paolo II Hospital, Olbia, Italy
| | - Giovanni Monni
- Department of Obstetrics and Gynecology, Prenatal and Preimplantation Genetic Diagnosis, Fetal Therapy, Microcitemico Pediatric Hospital, Cagliari, Italy
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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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Jiang J, Xue M. The treatment of cervical pregnancy with high-intensity focused ultrasound followed by suction curettage: report of three cases. Int J Hyperthermia 2019; 36:273-276. [PMID: 30676110 DOI: 10.1080/02656736.2018.1563914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Cervical pregnancy (CP) is a rare type of ectopic pregnancy and is considered to be a life-threatening condition due to the risk of severe hemorrhage. Unfortunately, no consensus on standard conservative treatment for CP has been established. The study objective was to evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) followed by suction curettage for cervical pregnancy. METHOD Three patients with cervical pregnancy undergoing high-intensity focused ultrasound followed by suction curettage were analyzed. Patient age, gestational age, endocervical mass, serum human chorionic gonadotrophin (HCG) level, blood loss, and time for normal menstruation recovery were recorded. RESULTS Three patients with cervical pregnancy were successfully treated with HIFU followed by suction curettage. After HIFU treatment, the fetal cardiac activity disappeared or the blood flow in the pregnancy tissue significantly decreased. The termination of the cervical pregnancy of all three patients was performed successfully without heavy bleeding. The estimated blood loss was 10-20 ml. The time for menstruation recovery was 30-45 days. No obvious complications of HIFU were observed in these cases. CONCLUSION High-intensity focused ultrasound followed by suction curettage seems to be considered as conservative management for patients who desire to preserve their uterus.
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Affiliation(s)
- Jianfa Jiang
- a Department of Obstetrics and Gynecology , The Third Xiangya Hospital of Central South University , Changsha , Hunan Province , China
| | - Min Xue
- a Department of Obstetrics and Gynecology , The Third Xiangya Hospital of Central South University , Changsha , Hunan Province , China
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Qingyun SMD, Sha H, Hong LMD, Taizhu Y, Qianqian GMD, Fan YMD. Contrast-enhanced Ultrasonography: A New Strategy to Confirm Cervical Pregnancy. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2019. [DOI: 10.37015/audt.2019.190821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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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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Martínez Díaz RA, Quintero Avendaño LJ, García González CA, Fernández De Castro Asis AM. Embarazo ectópico cervical: diagnóstico preciso y enfoque de manejo médico. Reporte de caso. UNIVERSITAS MÉDICA 2018. [DOI: 10.11144/javeriana.umed59-1.ecto] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
<p>El embarazo ectópico cervical es una condición exótica. Su diagnóstico y manejo plantean un desafío importante, dada su asociación con desenlaces maternos graves. La sospecha clínica y la juiciosa aplicación de los criterios diagnósticos permiten establecer modalidades de terapia conservativa. Este artículo reporta un caso de embarazo ectópico cervical con diagnóstico de imágenes de ultrasonido y resonancia nuclear magnética en el que se administró tratamiento con metotrexato. El seguimiento clínico, de los exámenes paraclínicos y de ultrasonido mostraron la resolución completa de la condición. Se revisan aspectos relacionados con el diagnóstico y tratamiento.</p>
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Brüggmann D, Kollascheck J, Quarcoo D, Bendels MH, Klingelhöfer D, Louwen F, Jaque JM, Groneberg DA. Ectopic pregnancy: exploration of its global research architecture using density-equalising mapping and socioeconomic benchmarks. BMJ Open 2017; 7:e018394. [PMID: 29025848 PMCID: PMC5652463 DOI: 10.1136/bmjopen-2017-018394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE About 2% of all pregnancies are complicated by the implantation of the zygote outside the uterine cavity and termed ectopic pregnancy. Whereas a multitude of guidelines exists and related research is constantly growing, no thorough assessment of the global research architecture has been performed yet. Hence, we aim to assess the associated scientific activities in relation to geographical and chronological developments, existing research networks and socioeconomic parameters. DESIGN Retrospective, descriptive study. SETTING On the basis of the NewQIS platform, scientometric methods were combined with novel visualising techniques such as density-equalising mapping to assess the scientific output on ectopic pregnancy. Using the Web of Science, we identified all related entries from 1900 to 2012. RESULTS 8040 publications were analysed. The USA and the UK were dominating the field in regard to overall research activity (2612 and 723 publications), overall citation numbers and country-specific H-Indices (US: 80, UK: 42). Comparison to economic power of the most productive countries demonstrated that Israel invested more resources in ectopic pregnancy-related research than other nations (853.41 ectopic pregnancy-specific publications per 1000 billlion US$ gross domestic product (GDP)), followed by the UK (269.97). Relation to the GDP per capita index revealed 49.3 ectopic pregnancy-specific publications per US$1000 GDP per capita for the USA in contrast to 17.31 for the UK. Semiqualitative indices such as country-specific citation rates ranked Switzerland first (24.7 citations per ectopic pregnancy-specific publication), followed by the Scandinavian countries Finland and Sweden. Low-income countries did not exhibit significant research activities. CONCLUSIONS This is the first in-depth analysis of global ectopic pregnancy research since 1900. It offers unique insights into the global scientific landscape. Besides the USA and the UK, Scandinavian countries and Switzerland can also be regarded as leading nations with regard to their relative socioeconomic input.
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Affiliation(s)
- Dörthe Brüggmann
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jana Kollascheck
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - David Quarcoo
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Michael H Bendels
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Doris Klingelhöfer
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
| | - Frank Louwen
- Department of Gynecology and Obstetrics, Goethe-University, Frankfurt, Germany
| | - Jenny M Jaque
- Department of Obstetrics and Gynecology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - David A Groneberg
- Division of Female Health and Preventive Medicine, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt
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J Y, Keepanasseril A, NS K, Maurya DK, Dorairajan G. Management of Cervical Pregnancy with a Combination of Systemic Methotrexate and Ultrasound-Guided Local Instillation of Methotrexate and Potassium Chloride: A Case Report and Review of the Literature. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Yavanasuriya J
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Kubera NS
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Dilip Kumar Maurya
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
| | - Gowri Dorairajan
- Department of Obstetrics & Gynecology, Jawaharlal Institute of Medical Education & Research, Puducherry, India
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Uterine artery embolization combined with curettage vs. methotrexate plus curettage for cesarean scar pregnancy. Arch Gynecol Obstet 2015; 294:71-6. [DOI: 10.1007/s00404-015-3952-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/28/2015] [Indexed: 11/25/2022]
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Outcomes of Bilateral Uterine Artery Chemoembolization in Combination with Surgical Evacuation or Systemic Methotrexate for Cervical Pregnancy. J Minim Invasive Gynecol 2015; 22:1029-35. [DOI: 10.1016/j.jmig.2015.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/22/2015] [Accepted: 05/23/2015] [Indexed: 11/20/2022]
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