EARLY DIAGNOSIS AND MANAGEMENT OF CERVICAL ECTOPIC PREGNANCY

##plugins.themes.academic_pro.article.main##

Dalenda Chelli
Kaouther Dimassi
Mouna Bouaziz
Soumaya Manai
Zouaoui Béchir
Ezzeddine Sfar
Héla Chelli
Mohamed Badis Chennoufi

Abstract

Background : Cervical pregnancy is the rarest of ectopic pregnancy. The classical treatment remains hysterectomy, in particular when diagnosis is made late. The possibilities of more and more premature diagnoses, sometimes before any clinical expression, let suspect the possibility of conservative treatments.
We report two cases of medical treatment for early diagnosed cervical pregnancies.
Aim : Through a review of the literature, we resume diagnostic criteria and various therapeutic possibilities.
Case reports: The two cases were diagnosed in the first trimester. The treatment consisted in intramuscular administration of methotrexate. The first patient had ultrasound-Guided feticide before the administration of methotrexate.
Conclusion: Actually, vaginal ultrasound allows early diagnosis of cervical pregnancies, even before the beginning of vaginal bleeding. This advancement allowed conservative treatment. In this situation, current citationsRaw is the methotrexate to which can be associated an intracardiac potassium chloride injection in case of embryo positive heart activity.

Keywords:

Ectopic pregnancy, Cervical pregnancy, Ultrasound, methotrexate

##plugins.themes.academic_pro.article.details##

References

  1. Parente JT, Ou CS, Levy J, Legatt E. Cervical pregnancy analysis: a review and report of five cases. Obstet Gynecol 1983; 62: 79-82.
  2. D. Riethmuller, L. Courtois, R. Maillet, J.-P. Schaal Recommandations pour la pratique clinique Prise en charge de la grossesse extra-utérine : les autres ectopies (cervicales et abdominales) J Gynecol Obstet Biol Reprod 2003 ; 32 (suppl. au n° 7:3S101-3S108.
  3. Itakura A, Okamura M, Ohta T, Mizutani S. Conservative treatment of a second trimester cervicoisthmic pregnancy diagnosed by magnetic resonance imaging.Obstet Gynecol 2003; 101 : 1149-51
  4. David MP, Bergman A, Delighdish L. Cervico-isthmic pregnancy caried to term. Obstet Gynecol 1980; 56: 247-52.
  5. Boyko TR, O'Brien JF. Cervical pregnancy: a case report. Ann Emerg Med. August 2001;38:177-180.
  6. Jozwiak EA, Ulug U, Akman MA, Bahceci M. Successful resection of a heterotopic cervical pregnancy resulting from intracytoplasmic sperm injection. Fertil Steril 2003; 79: 428-30.
  7. Dees HC. Cervical pregnancy associated with uterine leiomyomas. South Med J. 1966;59:900.
  8. Rubin I. Cervical pregnancy. Surg Gynecol Obstet. 1911;13:625-633.
  9. Raskin MM. Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol 1978;130:234-5.
  10. Ushakov FB, Elchalal U, Aceman PJ, et al. Cervical pregnancy: past and future. Obstet Gynecol Surv. 1996;52:45-59.
  11. Ismail Cepni, M.D., Pelin Ocal, M.D., Sanli Erkan, M.D., and Burcak Erzik, M.D. Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasoundguided aspiration and single-dose methotrexate Fertility Sterility 2004;81:
  12. E. KIRK, G. CONDOUS, Z. HAIDER, A. SYED, K. OJHA and T. BOURNE The conservative management of cervical ectopic pregnancies.Ultrasound Obstet Gynecol 2006; 27: 430-437
  13. Stovall TG, Ling FW, Smith WC, Felker R, Rasco BJ, Buster JE. Successful nonsurgical treatment of cervical pregnancy with methotrexate. Fertil Steril 1988; 50: 672-4.
  14. Camli L, Senyurt H, Kahramani H, Gokmen B. A case of cervical pregnancy treated with methotrexate. Gynecol Obstet Invest 1995; 40: 213-4.
  15. Melilli GA, Cormio G, Putignano G, Loverro G, Selvaggi L. Successful treatment of cervical and simultaneous cervicoisthmic pregnancy with methotrexate. Clin Exp Obstet Gynecol 2001; 28: 89-90.
  16. Kung FT, Chang SY. Efficacy of methotrexate treatment in viable and nonviable cervical pregnancies. Am J Obstet Gynecol 1999; 181: 1438-44
  17. Kaplan BR, Brandt T, Javaheri G, Scommegna A. Nonsurgical treatment of a viable cervical pregnancy with intra-amniotic methotrexate. Fertil Steril 1990; 53: 941-3.
  18. Bai SW, Lee JS, Park JH, Kim JY, Jung KA, Kim SK, et al. Failed methotrexate treatment of cervical pregnancy. Predictive factors. J Reprod Med 2002; 47: 483-8.
  19. Weston G, Kashyap R. Failed conservative management of cervical pregnancy despite falling beta-HCG. Aust N Z J Obstet Gynaecol 2001; 41: 346-7.
  20. Tuncer R, Uygur D, Kis S, Kayin S, Bebitoglu I, Erkaya S. Inevitable hysterectomy despite conservative surgical management in advanced cervical pregnancy: a case report. Eur J Obstet Gynecol Reprod Biol 2001; 100: 102-4.