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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.

This study of septic bursitis is among the largest reported. We were unable to identify presenting clinical features that differentiated patients treated surgically from those treated conservatively. There was no clear relationship between preceding trauma or bursitis site and clinical course, management, or outcomes. Patients with bursitis treated surgically were younger. Additional study is needed to identify patients who would benefit from early surgical intervention for septic bursitis.

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Cervical ectopic pregnancies represent fewer than 0.1% of all ectopic pregnancies but carry increased risk of significant hemorrhage and long-term reproductive consequences if not managed properly. In part due to the rarity of their occurrence, a standard-of-care protocol for management of cervical ectopic pregnancy (EP) other than hysterectomy does not exist. A trend toward more conservative management has broadened the literature; however, it is unclear what clinical characteristics can be used to guide choice of treatment.This retrospective study aimed to investigate published cases of cervical EP to determine how initial patient characteristics may be used to guide management strategies based on treatment success rate. PubMed, EMBASE, and Web of Science were searched for peer-reviewed citations published between 2000 and 2018. Included cases reported one of the following: initial β-human chorionic gonadotropin (β-hCG), crown-rump length (CRL), or gestational sac diameter. Cases were excluded that reported heterotopic pregnancy, were a result of in vitro fertilization, or included cervicoisthmic pregnancy. Patient characteristics abstracted from studies included age, gravidity, parity, initial β-hCG, CRL, gestational sac diameter, presence of fetal cardiac activity, and hemodynamic stability at initial presentation. Also abstracted were outcomes including initial treatment success and failure defined as resolution of cervical EP with the predefined treatment plan and requirement of additional and unplanned interventions due to predefined treatment plan failure, respectively. The primary exposure variable was the treatment, which was divided into systemic methotrexate (MTX), uterine artery embolization (UAE), dilatation and curettage (D&C), potassium chloride, MTX + UAE, D&C + UAE, and other. The primary study outcome was the initial success of planned treatments provided to the patient.A total of 204 articles from 44 countries including 454 cases were reviewed. Median β-hCG was 14,733 mIU/mL and median gestational age 7 weeks 4 days. Compared with MTX alone, other treatment methods had an increased likelihood of initial treatment success including UAE (

Approximately one-third of the world’s population is infected with Mycobacterium tuberculosis , and it is a leading cause of infertility in endemic countries. The global incidence of tuberculosis (TB) is growing at approximately 0.4% per year, and much faster in sub-Saharan Africa. TB causing fertility is rare in developed countries. We present a case of genital tuberculosis causing Asherman’s syndrome and resultant infertility. The patient is a 34-year-old P0 who presented to care after a prolonged period of secondary amenorrhea and infertility. She underwent a hysterosalpingogram which demonstrated no free spill and a diagnostic hysteroscopy which had findings of mottled endometrium. Pathology returned positive for Mycobacterium tuberculosis . The patient was treated with 9 months of antituberculous therapy. While she has not yet succeeded in becoming pregnant, the patient has started to notice cyclic spotting, indicating possible return of menses. This case highlights the importance of TB treatment and considering TB in patients who present with unexplained infertility.

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