Cervical ectopic pregnancy: surgical or medical treatment?
Tóm tắt
Cervical pregnancies are one of the rarest forms of ectopic gestations. The incidence of cervical ectopic pregnancies ranges between 1 in 1,000 to 95,000 gestations (Parente et al., Obstet Gynecol 62:79–82, 1983). Prior surgical trauma, including dilatation and curettage of the cervix, has been identified as one of the leading risk factors (Pisarska et al., Lancet 351:1115–1120, 1998; Yankowitz et al., Obstet Gynecol Surv 45:405–414, 1990). Cervical ectopic pregnancies are especially feared due to their associated life-threatening hemorrhage. Therefore, massive blood transfusions and emergency hysterectomy have often been required previously. Nevertheless, general guidelines for clinical management are lacking. In case reports medical and surgical treatment modalities are described. Overall, conservative management of an asymptomatic cervical ectopic pregnancy using methotrexate or potassium chloride seems to be superior to surgical intervention. The treatment of choice in patients suffering from symptomatic cervical ectopic pregnancy is still under discussion. In the case reported here, a combination of surgical and medical treatment conserving the patient’s childbearing capacity was successfully implemented. However, severe hemorrhage occurred and consecutive blood transfusions were urgently necessary. Emergency hysterectomy could be avoided.
Tài liệu tham khảo
“Why mothers die,” triennial report 2000–2002. Confidential enquiry into maternal deaths, UK
Parente JT, Ou CS, Levi J, Legatt E (1983) Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol 62:79–82
Cunningham FG, Gant NF, Leveno KJ, Gilstrap LC III, Hauth JC, Wenstrom KD (2001) Ectopic pregnancy, chapter 24. In: Williams obstetrics, 21st edn. McGraw-Hill, New York, pp 884–910
Condous G, Okaro E, Khalid A, Lu C, Van Huffel S, Timmerman D, Bourne T (2005) The accuracy of transvaginal ultrasonography for the diagnosis of ectopic pregnancy prior to surgery. Hum Reprod 20:1404–1409
Pisarska MD, Carson SA, Buster JE (1998) Ectopic pregnancy. Lancet 351:1115–1120
Yankowitz J, Leake J, Huggins G, Gazaway P, Gates E (1990) Cervical ectopic pregnancy: review of the literature and report of a case treated by single-dose methotrexate therapy. Obstet Gynecol Surv 45:405–414
Sivaligam N, Mak FK (2000) Delayed diagnosis of cervical pregnancy: management options. Singapore Med J 41:599–601
Tuncer R, Uygur D, Kis S, Kayin S, Bebitoglu I, Erkaya S (2001) Inevitable hysterectomy despite conservative surgical management in advanced cervical pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol 100:102–104
Frates MC, Benson CB, Doubilet PM et al (1994) Cervical ectopic pregnancy: results of conservative treatment. Radiology 191:773–775
Bader-Armstrong B, Shah Y, Rubens D (1989) Use of ultrasound and magnetic resonance imaging in the diagnosis of cervical pregnancy. J Clin Ultrasound 17:283–286
Mitra AG, Harris-Owens M (2000) Conservative medical management of advanced cervical ectopic pregnancies. Obstet Gynecol Surv 55:385–389
Ratten GJ (1983) Cervical pregnancy treated by ligation of the descending branch of the uterine arteries: case report. Br J Obstet Gynaecol 90:367–371
Saliken JC, Normore WJ, Pattinson HA, Wood S (1994) Embolization of the uterine arteries before termination of a 15-week cervical pregnancy. Can Assoc Radiol J 45:399–401
Cosin JA, Bean M, Grow D, Wiczyk H (1997) The use of methotrexate and arterial embolization to avoid surgery in a case of cervical pregnancy. Fertil Steril 67:1169–1171
Bachus KE, Stone D, Suh B, Thickman D (1990) Conservative management of cervical pregnancy with subsequent fertility. Am J Obstet Gynecol 162:450–451
Reginald PW, Reid JE, Paintin DB (1985) Control of bleeding in cervical pregnancy: two case reports. Br J Obstet Gynaecol 92:1199–1200
Wharton KR, Gore B (1988) Cervical pregnancy managed by placement of a Shirodkar cerclage before evacuation. A case report. J Reprod Med 33:227–229
Chew S, Anandakumar C (2001) Medical management of cervical pregnancy—a report of two cases. Singapore Med J 42:537–539
Goldberg JM, Widrich T (2000) Successful management of a viable cervical pregnancy by single-dose methotrexate. J Womens Health Gend Based Med 9:43–45
Margolis K (2000) Cervical pregnancy treated with a single intravenous administration of methotrexate plus oral folinic acid. Aust N Z J Obstet Gynaecol 40:347–349
Stovall TG, Ling FW, Smith WC, Felker R, Rasco BJ, Buster JE (1988) Successful nonsurgical treatment of cervical pregnancy with methotrexate. Fertil Steril 50:672–674
Kung FT, Chang SY (1999) Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol 181:1438–1444
Ushakov FB, Elchalal U, Aceman PJ et al (1996) Cervical pregnancy: past and future. Obstet Gynecol Surv 52:45
Riethmuller D, Courtois L, Maillet R, Schaal JP (2003) Ectopic pregnancy management: cervical and abdominal pregnancies. J Gynecol Obstet Biol Reprod (Paris) 32:S101–S108
Bai SW, Lee JS, Park JH, Kim JY, Jung KA, Kim SK, Park KH (2002) Failed methotrexate treatment of cervical pregnancy. Predictive factors. J Reprod Med 47:483–488
Hung TH, Shau WY, Hsieh TT, Hsu JJ, Soong YK, Jeng CJ (1998) Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 13:2636–2642
Hidalgo LA, Penafiel J, Chedraui PA (2004) Management of cervical pregnancy: risk factors for failed systematic methotrexate. J Perinat Med 32:184–186
Brand E, Gibbs RS, Davidson SA (1993) Advanced cervical pregnancy treated with actinomycin-D. Br J Obstet Gynaecol 100:491–492
Wolcott HD, Kaunitz AM, Nuss RC, Benrubi GE (1988) Successful pregnancy after previous conservative treatment of an advanced cervical pregnancy. Obstet Gynecol 71:1023–1025
Honda T, Hasegawa M, Nakahori T, Maeda A et al (2005) Perinatal management of cervicoisthmic pregnancy. J Obstet Gynaecol Res 31:332–336