Conservative management of advanced cervical ectopic pregnancy
Marzieh Ghafarnejad (IR), Nafiseh Saedi (IR)
[ghafarnejad] tehran university, [saedi]
Introduction: Cervical ectopic pregnancy is rare. The incidence varies between 1 in 1000 to 1 in 18000 of pregnancies. Treatment choices may be radical or conservative. When radical, a hysterectomy is usually performed. The conservative approach may be surgical or medical. Surgical approach implies hypo-gastric or uterine artery ligation or embolization, curettage with or without cerclage, or the insertion of a Foley catheter balloon in cervical canal bed to tampon-ad hemorrhagic bed . Medical treatment may be systemic or local intra-sac injection of MTX, local intra-sac injection of potassium chloride, diluted vasopressin injection deeply, in different points of cervix. The main goal of this lecture is to describe a conservative management of cervical ectopic pregnancy even in advanced gestational age. 2. Methods: report of successful management of advanced cervical ectopic pregnancy at 12th week of gestation; using review articles and case reports from literature including ; intra amniotic sac and systemic metotrexate injection, diluted vasopressin injection in the location of cervical vessels, insertion of Foley catheter to tampon of the hemorrhagic cervical bed and finally dilatation & curettage. Results: patients should be managed based on gestational age, titer of beta- HCG and personal characteristics. The utilization of various procedures in the treatment could result in preserving the uterus even in advanced cervical ectopic pregnancy. Conclusion: Early diagnosis and treatment could result in fertility preservation in cervical ectopic pregnancy Key words: Cervical ectopic pregnancy- metotrexate- vasopressin-uterine preservation