Conservative treatment of cervical pregnancy by curettage and local prostaglandin injection

Abstract

Recently, various conservative regimens for the treatment of cervical pregnancy have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used drugs. The success of conservative treatment depends on early preoperative diagnosis. We report three cases of first trimester cervical pregnancy, successfully treated by curettage to evacuate the conceptus, followed by local prostaglandin instillation to prevent severe haemorrhage. In one patient, intra-amniotic instillation of hyperosmolar glucose was necessary to terminate fetal cardiac activity. beta-Human chorionic gonadotrophin returned to normal within 3 weeks in one patient and within 7 weeks in another, both of whom became pregnant again within 1 year, resulting in term deliveries. The third patient was lost to follow-up after 1 week. The advantage of prostaglandin and curettage is the absence of major side-effects to the mother or the fetus of a subsequent pregnancy. The management strategies used in the treatment of cervical pregnancies and the results obtained since the introduction of methotrexate in 1989 are discussed in the context of previously published literature. The incidence of subsequent pregnancies among women treated medically versus women treated surgically is reported.

Medical Management of Cervical Ectopic Pregnancy

“…4 The rarity of the condition has prevented any retrospective studies, and the association of cervical pregnancy with all these factors remains weak. 10,11 In our case, none of the above mentioned predisposing factors were found. Regarding symptoms, cervical pregnancy classically presents with painless first trimester vaginal bleeding, although several case reports describe patients with cramping pain.…”

Combined Systemic and Hysteroscopic Intra-Amniotic Injection of Methotrexate Associated with Hysteroscopic Resection for Cervical Pregnancy: A Cutting-Edge Approach for an Uncommon Condition

“…It accounts for <1% of ectopic pregnancies, with an incidence of approximately 1 in 9000 deliveries [2]. Risk factors for CP include utero-cervical anomalies, cervical stenosis, intrauterine device use, previous uterine surgery, pelvic inflammatory disease, and in vitro fertilization [3].…”

Alternative Treatment Method for Cervical Ectopic Pregnancy

“…[4] In the literature, multiple treatment modalities and conservative approaches have been offered, including systemic or local application of methotrexate, [5,6] local prostaglandin injection in combination with D&C, [7] cervical cerclage, [8] selective uterine artery embolization, [9] D&C and Foley catheter placement, [10,11] and laparoscopic uterine artery ligation and hysteroscopic endocervical resection. [12] As a radical approach, hysterectomy is performed in cases where profuse bleeding threatens life or in patients who are infertile.…”