Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Hu, Jun; Tao, Xin; Yin, Ling; Shi, Yangyang

doi:10.1111/1471-0528.14005

Cited by 26 publications

(23 citation statements)

References 21 publications

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“…Although the aetiology of CP is unknown, a history of dilation and curettage in a previous pregnancy has been identified as risk factors in nearly 70% of cases [ 1 ]. Other predisposing factors are previous caesarean delivery, cervical surgery, endometritis, use of an intrauterine device and in-vitro fertilization (IVF) [ 3 ]. Diagnosis involves a combination of clinical symptoms, serology, and ultrasound.…”

Section: Introductionmentioning

confidence: 99%

Ectopic Cervical Pregnancy: Treatment Route

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

Ectopic Cervical Pregnancy: Treatment Route

et al. 2020

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“…A partir de la búsqueda en la literatura se encontraron 130 títulos, de estos se identificaron 22 estudios que correspondieron a series y reportes de caso que cumplieron con los criterios de inclusión: 3 fueron descritos como estudios prospectivos (18)(19)(20), 6 estudios retrospectivos (5, 14, 21-24), 3 series de casos (25)(26)(27), y 10 reportes de caso (7,16,(28)(29)(30)(31)(32)(33)(34)(35). Un total de 15 estudios evaluaron el tratamiento médico (5, 7, 14, 18, 21-23, 25, 28-33, 35) y 9 el tratamiento quirúrgico (7,16,19,20,24,26,27,34,35). Los textos seleccionados fueron publicados por grupos de varios países como Taiwán (20), India (7,35), Grecia (18), Canadá (5,14,31), Turquía (22), Italia (16,19), Chipre (26), Egipto (26), Estados Unidos (23,25,34), China (24), Corea del Sur (27), España (33), México (29,), Venezuela (30), Cuba (32) y Colombia (28).…”

Section: Resultsunclassified

“…Hu et al (24), en un estudio retrospectivo de 19 pacientes con embarazo cervical, realizaron EAU seguida de curetaje a las 24-72 horas posteriores al procedimiento endovascular. Ninguna de las 19 pacientes presentó sangrado vaginal u otras complicaciones asociadas en el posoperatorio.…”

Section: Tratamiento Quirúrgico Conservadorunclassified

Manejo conservador en una paciente con embarazo ectópico cervical en Nariño, Colombia: reporte de caso y revisión de la literatura

Bolaños-Bravo

Ricaurte-Fajardo

Zarama-Márquez

et al. 2019

Rev. Colomb. Obstet. Ginecol.

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RESUMENObjetivos: reportar el caso de un embarazo cervical (EC) que recibió manejo conservador exitoso y realizar una revisión de la literatura sobre el tratamiento médico y quirúrgico conservador. Materiales y métodos: se presenta el caso de una paciente con embarazo cervical, quien recibió manejo farmacológico con metotrexate (MTX) y posterior legrado con evolución clínica satisfactoria. Se realizó una búsqueda de artículos en Medline vía PubMed, LILACS, SciElo y Google académico con los términos: "cervical ectopic pregnancy", "conservative treatment", "curettage", "methotrexate", 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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“…En effet, le curetage cervical a lui seul expose à des risques majeurs d'hémorragie cataclysmique, vue la faible capacité de rétraction du col et donc d'hémostase spontannée. Hu et al y ont associé une embolisation des artères utérines, entre 24 et 72 heures avant la réalisation du curetage, avec un taux de succès de 100% pour les 19 cas de leur série [19]. Ash et al ont décrit en 1996 une prise en charge par résection hystéroscopique avec succès [20].…”

Section: Discussionunclassified

Grossesse cervicale à 7 semaines d'aménorrhée: défis de la prise en charge

2017

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La grossesse cervicale est une forme extrêmement rare de grossesse ectopique qui engage le pronostic vital maternel en raison du risque important d'hémorragie. Nous rapportons l'observation d’une patiente âgée de 35 ans, ayant accouché une première fois par césarienne et qui a présenté une grossesse cervicale diagnostiquée à 7 semaines d'aménorrhée. La prise en charge au sein de notre structure a fait appel au traitement médical puis chirurgical après échec du premier. L'intérêt de cette observation réside dans la démarche diagnostique et les différentes étapes de prise en charge thérapeutique.Cervical pregnancy is an extremely rare form of ectopic pregnancy which can be life-threatening due to the high risk of hemorrhage. We report a case of a 35-year-old woman, who first gave birth by caesarean section, with cervical pregnancy diagnosed at 7 weeks of amenorrhea. Patient management within our structure was based on medical treatment followed by surgery after failure of medical treatment. The importance of this study lies in the diagnostic approach and in the different stages of therapeutic management.

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Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Cited by 26 publications

References 21 publications

Ectopic Cervical Pregnancy: Treatment Route

Ectopic Cervical Pregnancy: Treatment Route

Manejo conservador en una paciente con embarazo ectópico cervical en Nariño, Colombia: reporte de caso y revisión de la literatura

Grossesse cervicale à 7 semaines d'aménorrhée: défis de la prise en charge

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