The conservative management of cervical ectopic pregnancies

Kirk, E.; Condous, G.; Haider, Z.; Syed, Aslam; Ojha, Kamal; Bourne, Tom

doi:10.1002/uog.2693

Cited by 122 publications

(91 citation statements)

References 37 publications

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“…We found advanced maternal age was the only risk factor that was significantly associated with extratubal gestations compared to pregnant women with tubal gestations. Similar findings were also reported in other studies: Median age of 37 years in cervical pregnancies, 16 mean age of 35 years in cesarean scar pregnancies 17 and mean age of 31.2 years in abdominal pregnancies. 18 Highest rates of ectopic pregnancies occurred in women aged 35 to 44 years.…”

Section: Discussionsupporting

confidence: 92%

A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations

Marakani¹,

Gundabattula²,

Dasari³

et al. 2013

International Journal of Infertility &Amp; Fetal Medicine

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Aim: To compare risk factors for extratubal gestations with tubal gestations. Materials and methods:Case control design with retrospective examination of an electronic database to identify ectopic gestations. Ectopic gestations were confirmed through ultrasound examination or serum beta hCG levels. We defined an ectopic gestation as implantation of pregnancy outside uterine cavity; tubal ectopic including implantation in the tube, isthmic, ampullary, or fimbrial and extratubal ectopic including implantation in the ovaries, cervix, abdomen, interstitia or cesarean scar.Results: Ninety-one (1.1%, 95% CI: 0.9-1.3, 1 in 90 pregnancies) of 8,203 pregnancies during the study period were ectopic gestations including 69 (0.8%, 95% CI: 0.7-1.1, 1 in 120 pregnancies) tubal gestations and 22 (0.3%, 95% CI: 0.2-0.4, 1 in 372 pregnancies) gestations in extratubal locations. Extratubal ectopic gestations were more common in women with advanced maternal age (odds ratio: 7.4, 95% CI: 1.3, 43.9, p = 0.03) compared to women with tubal ectopic gestations. Conclusion:Risk factors for extratubal gestation did not differ from risk factors for tubal gestations except for advanced maternal age. Pregnant women with advanced maternal age have to be additionally counseled on the increased risk for extratubal gestations.

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Section: Discussionsupporting

confidence: 92%

A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations

Marakani¹,

Gundabattula²,

Dasari³

et al. 2013

International Journal of Infertility &Amp; Fetal Medicine

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“…According to the same Hung et al meta-analysis, overall success rate using single dose of MTX was 62%, although when cardiac activity was not present 91% of cases were successful and when cardiac activity was present -only 40%. More recent studies show overall MTX success rate as high as 81.3-83% [18]. More advanced pregnancies, when cardiac activity is discovered, should be treated with MTX and potassium chloride in addition to cause fetal death and facilitate resorption of larger gestational sac [19].…”

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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“…medical managements in the from of systemic or intraamniotic MTX, with or without intra-amniotic potassium chloride administration criteria for conservative treatment are patient should be haemodynamically stable, have no haemoperitonium on TVS scanning , have normal kidney and liver function 21 . Additional specific requirements for expectant managemants are no fetal cardiac activity 22 . Serum hCG level were measured on day 1, 4 and 7 with day 1 being the day of first injection of MTX.…”

Section: Discussionmentioning

confidence: 99%

“…A review of English literature from 1911 to1994 found 39 cervical ectopic pregnancies and 29 patient were treated conservatively 27 . Out come of most of the pregnancies after cervical ectopic will lead to term deliveries but there is possibility of preterm labour in such cases [22][23] .…”

Section: Discussionmentioning

confidence: 99%

Cervical Ectopic Pregnancy: A Puzzling Event

Begum

Ferdous

Sultana

et al. 2014

Chatt Maa Shi Hosp Med Coll J

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Cervical ectopic pregnancy is the implantation of the conceptus within the cervix below the level of internal os 1 . Such pregnancy typically aborts within the first trimester, if it is implanted closer to the uterine cavity called cervico isthmic pregnancy it may continue longer 2 . Cervical pregnancy accounts for less than 1% of all ectopic pregnancies, with an estimated incidence of 1 in 2500 to 1 in 18000. Though the pregnancy in this area is uncommon but possibly life threatening condition due to risk of severe hemorrhage and may need hysterectomy 2,3 . Early detection and conservative approach of treatment limit the morbidity and preserve fertility. A 37 year old lady para 4+0 diagnosed as a case of cervical ectopic pregnancy with intractable bleeding and save the patient by emergency hysterectomy to control hemorrhage. The case is reported here for its relative rarity.

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The conservative management of cervical ectopic pregnancies

Abstract: ABSTRACT

Cited by 122 publications

References 37 publications

A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations

A Case Control Study Comparing Risk Factors for Ectopic Gestation in Unusual and Tubal Gestations

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

Cervical Ectopic Pregnancy: A Puzzling Event

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