Non-radical surgical treatment of cervical pregnancy after IVF/ET: a case report
Authors:
MUDr. Renáta Krajčovičová; prim. MUDr. Robert Hudeček, Ph.D.
Authors‘ workplace:
Gynekologicko-porodnická klinika LF MU a FN Brno
Published in:
Prakt Gyn 2008; 12(1): 28-32
Overview
Introduction:
Cervical pregnancy is rare type of ectopic pregnacy, which is characteristed by implantation of gestational sac in cervix. Incidence move between 1 : 2500–1 : 18 000. The most severe complication of cervical pregnancy is massive even a life threatening haemorrhage from placenta accreta ending often with hysterctomy. Ultrasonographic visualization of gestational sac with fetal cardiac action or evidence of endocervical trofoblastic invasion by color Doppler visualisation of peritrofoblastic flows have absolutely priority in diagnostic of cervical pregnancy. Correlation with increasing serum levels of hCG is allways very important. We can use surgical intervence or conservative medicamentous treatment in the therapy of cervical pregnanacy. Objektive − presenting of high effective, patient unweighting nonradical surgical treatment of cervical pregnancy using casuistic and providing a self-contained overview of the above issue.
Material and methods:
Reference cervical pregnancy casuistic following IVF/ET, diagnostic algorithm and surgical treatment.
Conclusion:
There is not available therapeutic guideline with regard to oneness of incidence. Alternative of medicamentous or surgical therapy have to be under discussion individually in each case. Our surgical operation – revisio canalis cervicis uteri et cavi uteri separata was performed under ultrasonographic control with ligation rami cervicalis arteriae uterinae and aplication of uterotonics. The risk of hysterectomy is minimal by lege artis performing of operation. Possibility of spontal pregnancy or repetition of IVF/ET are staying well-preserved.
Key words:
cervical pregancy – ectopic pregnancy – extrauterine pregnnancy – methotrexate – metrorrhage – cervical abortion
Sources
1. Parente JT et al. Cervical pregnancy analysis: A review and repor of five cases. Obstet Gynecol 1983; 62: 79-82.
2. Ventruba P, Čupr Z, Pilka L et al. Faktory sdružené se vznikem mimoděložního těhotensví po fertilizaci in vitro a transferu embrya. Asis Reprod 1992; 2: 10-11.
3. Uhlíř M et al. Diagnostika a léčba časné cervkální gravidity. Čes Gynek 1999; 1: 58.
4. Dicker D, Feldberg D, Samuel N et al. Etiology of cervical pregnancy. Association with abortion, pelvic patology, IUDs and Asherman´s syndrome. J Reprod Med 1985; 30(1): 25-27.
5. Čupr Z, Pospíšil J, Miličková E. Graviditas portionis vaginalis cervicis uteri. Zentralbl Gynakol 1973; 95: 1385-1387.
6. Zwinger A. Etiopatogeneze mimoděložního těhotenství. In: Zwinger A et al. Porodnictví. Praha: Galén 2004: 183-184.
7. Driál D et al. Ultrazvukový průkaz vitální ektopické gravidity. Gynekolog 2003; 12: 161.
8. Kiss J. Űber die zervikale Swargerschaft. Zentralbl Gynakol 1958; 80(33): 1267-1275.
9. Čupr Z, Rohanová M, Pospíšil J et al. Morphology, Clinics and Etiopathogenesis of Cervical Gravidity. Scr Med 1971; 44(8): 477.
10. Api O, Unal O, Api M et al. Ultrasonographic appearance of cervical pregnancy following successful treatment with methorexate. Ultrasound Obstet Gynecol 2006; 26: 845-847.
11. Borrelli PT, Hitler SA, Docherty SM et al. Human chorionic gonadotropin isoform in the diagnosis of ectopic pregnancy. Clin Chem 2003; 49: 2045-2049.
12. Suzumori N, Katano K, Sato T et al. Conservative treatment by angiographic Artury embolization of 11-week cervical pregnancy after period of heavy bleeding. Fertil Steril 2003; 80: 617-619.
13. Doekhie BM, Schats R, Hompes PG. Cevical pregnancy treated with local methotrexate. Eur J Ostet Gynecol Reprod Biol 2005; 122: 128-130.
14. Gosakan R, Arutchelvam S, Gergis HH et al. Medical managment of a cervical pregnancy. Obstet Gynaecol 2005; 25: 82-83.
15. Tinelli A, Malvasi A, Vergara D et al. Emergency surgical procedre for failed methotrexate treatment of cervical pregnancy: A case report. EJ Contrac Reprod 2007; 12(4): 391-394.
16. Hajenius PJ, Roos D, Ankum VM et al. Are serum human chorionic gonadotropin clearance curves of use in monitoring methotrexate treatment in cervical pregnancy? Fertil Steril 1998; 70: 362-365.
17. Bakour SH, Thompson PK, Khan KS. Successful conservative managment of cervical ectopic pregnancy with combination of methotrexate, mifepristone, surgical evacuation and tamponade using a double balloon three-way catheter. J Obstet Gynaecol 2005; 25: 616-618.
18. Nieuwkerk PT, Hajenius PJ, Van der Veen F et al. Systemic methotrexate therapy versus laparoscopic salpingostomy in tubal pregnancy. Part II. Patients preferences for sysemic methotrexate. Fertil Steril 1998; 70: 518-522.
19. Hung TH, Shau WY, Hsieh TT et al. Prognostic factors for an unsatisfactory primary metotrexate treatment of cervical pregnancy: A quantitative rewiev. Hum Reprod 1998; 13: 2636-2642.
20. Karsddorp et al. Successful treatment with methotrexate of five vital interstitial pregnancies. Hum Reprod 1992; 7: 1164-1169.
21. Yildizhan B. Diagnosis and treatment of early cervical pregnancy: a case report and literature review. Clin Exp Obstet Gynecol 2006; 32: 254-256.
22. Fu-Tsai K, Hao L, Te-Yao H et al. Diffeerential diagnosis of suspect cervical pregnancy and conservative treatmentwith the combination of laparoscopy-assisted uterine artery ligation and hysteroscopic endocervical resection. Fertil Steril 2004; 81: 1642-1649.
23. Stovall TG, Ling FV. Single dose of methotrexate: An expanded clinical trial. Am J Obstet Gynecol 1993; 168: 1759.
Labels
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Practical Gynecology
2008 Issue 1
Most read in this issue
- Ultrasound biometry of the head in breech presented fetuses
- Retrograde ejaculation – one of the causes of male infertility
- How women respond to combined NuvaRing® contraception
- Onset of menarche, development of secondary sexual characteristics and secular trend in girls in Bratislava region