Ectopic Cervical Pregnancy: Treatment Route

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.

Management of Non-Tubal Ectopic Pregnancies: A Single Center Experience

“…For CP, we suggest the hysteroscopic approach, alone or combined with systemic MTX, also in cases of patients with β-hCG serum levels higher than 5000 UI/mL [21]. In case of local injection of MTX, hysteroscopy appears advantageous in comparison to ultrasonography.…”

Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy

“…Clinically, based on our retrospective review, parameters such as gestational age, values of serum b HCG, and the presence of fetal cardiac activity have to be taken into consideration when choosing the best treatment route for the patient. 2,7 Our main conclusion based on our review of the literature and our center's experience is that an approach to each patient remains individual. Because CEP is a rare condition, there are no universally accepted protocols for the management of CEP.…”

“…1 The incidence of CEP ranges between 1 in 1,000 and 1 in 18,000 of all pregnancies. 2,3 Due to the lack of universally accepted guidelines for diagnosing and managing CEP, there is a discrepancy in the reported incidence. Even though the exact pathophysiology of CEP remains unknown, some of the major risk factors are well-documented: previous dilatation and curettage, previous cesarean section delivery, surgical procedures for cervical pathology, and assisted reproductive technologies (ART).…”

“…5 Advances in technology now provide an early diagnosis of CEP, allowing for conservative medical and minimally invasive surgical procedures. 2,5 We present our experience of 3 patients with CEP treated at a single center with small-caliber hysteroscopy as a single treatment method. of ectopic pregnancy.…”

Cesarean Scar Pregnancy Treated by Artery Embolization Combined with Diode Laser: A Novel Approach for a Rare Disease

“…A relatively new approach is the use of hysteroscopy to remove cesarean scar pregnancies, which offers numerous advantages, like visually directed treatment, reduced operative bleeding, shorter stay, and better patient compliance [ 3 , 22 , 23 , 24 , 25 , 26 ].…”