Successful Management of a Consecutive Cervical Pregnancy by Sonographically Guided Transvaginal Local Injection

Ferrara, Lauren; Belogolovkin, Victoria; Gandhi, Manisha; Litton, Christian; Jacobs, Adam; Saltzman, Daniel H.; Rebarber, Andrei

doi:10.7863/jum.2007.26.7.959

Cited by 25 publications

(24 citation statements)

References 30 publications

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“…Ten years later, a review of the available data by Van de Meerssche et al 2 showed that only 15% of the patients required hysterectomy. Ferrara et al 10 recently reviewed 90 cases of cervical pregnancy treated conservatively using local injections and they found a surprisingly low rate (1.1%) of hysterectomy. The management depends on the clinical presentation of this condition.…”

Section: T H E R a P E U T I C S T R A T E G I E Smentioning

confidence: 97%

Cervical pregnancy: A case series and a review of current clinical practice

Cipullo

Cassese

Fasolino

et al. 2008

The European Journal of Contraception & Reproductive Health

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Five consecutive cases of cervical pregnancy (CP) are presented. In four cases, the diagnosis was made at routine check-ups and these were all treated conservatively. In the fifth case, an erroneous diagnosis of inevitable abortion was made, in a patient presenting with profuse vaginal bleeding. Persistent bleeding following curettage required an emergency hysterectomy, after failure of compressive methods. From the four cases treated conservatively, three received standard methotrexate i.m. (MTX) in combination with bilateral uterine artery embolization (UAE). In one case MTX was followed by intraamniotic puncture and instillation of KCl due to persistent embryonic heartbeat. A spontaneous evacuation of the cervical pregnancy occurred in all patients treated conservatively. We postulate that the preventive use of uterine artery embolization in combination with standard MTX treatment could contribute to reduce the risk of excessive bleeding and facilitate spontaneous expulsion. Possible detrimental effects of the treatment on subsequent reproductive capacities and obstetrical outcome are also pointed out. The diagnostic methods and therapeutic approaches are discussed and the literature is reviewed. With referral to the first case of our series, which required an emergency hysterectomy, we want to stress the importance of an early diagnosis for a correct management of this condition.

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Section: T H E R a P E U T I C S T R A T E G I E Smentioning

confidence: 97%

Cervical pregnancy: A case series and a review of current clinical practice

Cipullo

Cassese

Fasolino

et al. 2008

The European Journal of Contraception & Reproductive Health

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“…The most commonly reported medications are MTX and KCl. 13,21,27,35,41,44,46,51 Administration of intraamniotic prostaglandins F2α have also been described by Spitzer et al and Vega et al 59,60 Mefiprestone administered along with MTX to induce feticide has been reported by Pathak et al and Shreshta et al 43,48 In the presence of progesterone, mifepristone acts as a competitive receptor antagonist at the progesterone receptor. Mifepristone induces decidual breakdown indirectly, leading to trophoblast detachment and resulting in decreased syncytiotrophoblast production of HCG, which in turn causes decreased production of progesterone by the corpus luteum.…”

Section: Medical Therapymentioning

confidence: 90%

“…7,12 The most common risk factor is dilatation and curettage (69%), followed by previous caesarean delivery (35%). 13 Other risk factors include Asherman's syndrome, intrauterine devices, tumours and anomalies of reproductive tract. 5,14 One patient in our study had curettage and prior caesarean history.…”

Section: Etiologymentioning

confidence: 99%

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Cervical ectopic pregnancy: 10 year experience at tertiary care hospital and current literature review

Prameela

Dev

2016

Int J Reprod Contracept Obstet Gynecol

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“…Most common risk factors are dilatation and curettage (70%) and cesarean section (35%) -both of which were performed previously to our presented patient [3,5]. Usual symptoms are painless vaginal bleeding (91%), followed by a period of amenorrhea, and inguinal pain (28%) [6,7].…”

Section: Discussionmentioning

confidence: 99%

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

Jukna¹,

Diržauskas²

2017

LietChirur

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BackgroundCervical pregnancy is a rare pathology with unclear etiology. This condition can be life-threatening and in certain situations be treated with total abdominal hysterectomy, although due to improving diagnostics, approach to cervical pregnancy's management has been changing towards fertility preserving treatment. Case report 38 years old patient with vaginal bleeding and lower abdomen pain was admitted to Klaipėda Seamen's hospital. After thorough evaluation, clinical diagnosis of cervical pregnancy was confirmed. Different approaches were considered and total abdominal hysterectomy was determined as most suitable method. Surgery was successful and post-operative period was uneventful. Discussion Ultrasonography is the main diagnostic tool used to observe cervical ectopic pregnancy. Speculum and bimanual examination usually show prominent findings, assisting cervical pregnancy's diagnose. Prior to improved diagnostic tools, total abdominal hysterectomy was the main approach treating cervical pregnancy. Now conservative management using methotrexate is considered as the first-line treatment and frequency of other fertility preserving procedures as suction curettage and tamponade or uterine artery embolization are increasing. Conclusion Data is limited because of cervical pregnancy's rarity and every case of this condition has to be assessed separately. Desire to preserve fertility and patient's condition must be taken to account before making decision on how cervical pregnancy will be managed. Key words: cervical pregnancy, ultrasonography, total hysterectomy 199 Cervical ectopic pregnancy: a case report and review of the literature Įvadas Nėštumas gimdos kaklelyje yra reta patologija, kurios tiksli etiologija nežinoma. Ši būklė gali būti gyvybiškai pavojinga ir gydoma totalia laparotomine histerektomija, tačiau tobulėjanti diagnostika leidžia ektopinį nėštumą gimdos kaklelyje gydyti išsaugant vaisingumą. Klinikinis atvejis 38 metų pacientė buvo paguldyta į Klaipėdos Jūrininkų ligoninę dėl kraujavimo iš makšties ir skausmo apatinėje pilvo dalyje. Nuodugniai ištyrus pacientę, buvo diagnozuotas nėštumas gimdos kaklelyje. Apsvarsčius skirtingas gydymo taktikas, totali laparotominė histerektomija buvo pasirinka kaip tinkamiausias gydymo būdas. Operacija buvo sėkminga, pooperacinis laikotarpis sklandus. Diskusija Ultragarso tyrimas yra pagrindinis nėštumo gimdos kaklelyje diagnostikos metodas. Skėtikliais ir bimanualinio tyrimo metu dažniausiai randami svarbūs pakitimai, kurie padeda pagrįsti diagnozę. Totali laparotominė histerektomija buvo pagrindinis gydymo metodas, tačiau tobulėjant diagnostikos metodams metotreksatas tapo pirmos eilės pasirinkimu kaklelinio nėštumo atveju. Kiti konservatyvūs gydymo metodai, pavyzdžiui, gimdos ir gimdos kaklelio abrazija, lydima tamponavimo Foley kateteriu, ar gimdos arterijos embolizacija, tampa vis populiaresni. Išvados Duomenys apie kaklelinį nėštumą yra riboti dėl šios patologijos retumo ir kiekvienas atvejis turi būti vertinamas individualiai. Noras išsaugoti vaising...

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Successful Management of a Consecutive Cervical Pregnancy by Sonographically Guided Transvaginal Local Injection

Abstract: Conservative management of cervical pregnancy using local injection has been reported to have a low complication rate and a high efficacy for cure.

Cited by 25 publications

References 30 publications

Cervical pregnancy: A case series and a review of current clinical practice

Cervical pregnancy: A case series and a review of current clinical practice

Cervical ectopic pregnancy: 10 year experience at tertiary care hospital and current literature review

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

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