Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy

Mori, Karen Hiromi; Tavares, Bárbara Virgínia; Yela, Daniela Angerame; Baccaro, Luis Francisco Cintra; Juliato, Cassia Raquel Teatin

doi:10.1055/s-0042-1757954

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev Bras Ginecol Obstet 44 (11) • 2022 • https://doi.org/10.1055/s-0042-1757954 copy

Experience of a Tertiary Service in the Treatment of Women with Cervical Pregnancy

Experiência de um serviço terciário no tratamento de mulheres com gravidez ectópica cervical

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Cervical pregnancy is challenging for the medical community, as it is potentially fatal. The treatment can be medical or surgical; however, there are no protocols that establish the best option for each case. The objective of the present study was to describe the cases of cervical pregnancy admitted to a tertiary university hospital over a period of 18 years.

Methods

A retrospective study based on a review of the medical records of all cervical pregnancies admitted to the Women's Hospital at Universidade Estadual de Campinas, Southeastern Brazil, from 2000 to 2018.

Results

We identified 13 cases of cervical pregnancy out of a total of 673 ectopic pregnancies; only 1 case was initially treated with surgery because of hemodynamic instability. Of the 12 cases treated conservatively, 7 were treated with single-dose intramuscular methotrexate, 1, with intravenous and intramuscular methotrexate, 1, with intravenous methotrexate, 1, with 2 doses of intramuscular methotrexate, and 2, with intra-amniotic methotrexate. Of these cases, one had a therapeutic failure that required a hysterectomy. Two women received blood transfusions. Four women required cervical tamponade with a Foley catheter balloon for hemostasis. There was no fatal outcome.

Conclusion

Cervical pregnancy is a rare and challenging condition from diagnosis to treatment. Conservative treatment was the primary method of therapy used, with satisfactory results. In cases of increased bleeding, cervical curettage was the initial treatment, and it was associated with the use of a cervical balloon for hemostasis.

Keywords
cervical pregnancy; ectopic pregnancy; methotrexate; surgery; treatment

N^O	Age (years)	Parity index	GA	Initial diagnosis	Ultrasonography findings	β-hCG (IU/l)	Initial treatment	Additional treatment
1	39	G2C1	6 + 2	Anembryonic pregnancy	4-cm cervical gestational sac	129,57	Methotrexate IM	None
2	26	G6C2A3	6 + 5	Cervical ectopic pregnancy	Hematometra 79 × 47 × 62 mm, cervical gestation, and invasion of decidua into the myometrium, FHB present	88,878	Cervical curettage, vacuum aspiration, Foley catheter balloon	None
3	30	G3C1A1	10 + 5	Cervical ectopic pregnancy	Isthmic pregnancy, CRL 38 mm, FHB present	75,810	AF aspiration, intracardiac injection of xylocaine, and intra-amniotic injection of methotrexate 50 mg	None
4	32	G6P5C3	9 + 5	Cervical ectopic pregnancy in abortion	Cervical ectopic pregnancy in abortion: heterogeneous oval image, 5.7 × 8.4 mm	4,585	Methotrexate EV and methotrexate IM	None
5	28	G4P2A1	8 + 0	Embryonic death in the cervical region	Gestational sac 25 × 19 × 14 mm, with 12-mm embryo in the cervical region, without FHB	3,678	Methotrexate IM	None
6	35	G3P1A1	9 + 3	Cervical ectopic pregnancy	28-mm gestational sac with an embryo, 11 mm distant from the IO, FHB present	≥ 10,00	AF aspiration, intracardiac injection of xylocaine and intra-amniotic injection of methotrexate 87.5 mg	None
7	31	G3C2	6 + 1	Cervical ectopic pregnancy	Cervical ectopic pregnancy of GA 6 + 2, with live embryo	≥ 10,000	Methotrexate IM	Cervical curettage
8	25	G3C1A1	10 + 2	Ectopic pregnancy in Cesarean section scar	Cervical region just below cesarean section scar – an image of 23 × 27 × 33 mm may correspond to cervical ectopic pregnancy	642	Methotrexate IM	None
9	21	G3P1A1	9 + 0	Incomplete abortion in the cervical canal	Heterogeneous nodular formation in the cervical canal with extension to the serosa measuring 42 × 38 × 35mm, with gestational sac without embryo	6,598	Methotrexate IM	Curettage and Foley catheter balloon
10	37	G3P2C1	9 + 0	Cervical ectopic pregnancy	Cervical ectopic pregnancy with the presence of the gestational sac only	10,185	Methotrexate IM	None
11	44	G1P0	7 + 1	Cervical ectopic pregnancy	Pregnancy in the cervical-uterine body transition, with embryo and FHB present	78,839	Methotrexate EV	Curettage, Foley catheter balloon, hysterectomy
12	33	G2A1	5 + 6	Cervical ectopic pregnancy	Anechoic image in cervical region 21 × 13 × 11mm, diameter: 15mm, 2.9-mm CRL embryo, FHB present	7,683	Methotrexate IM	Methotrexate IM
13	33	G1	6 + 3	Cervical embryonic death	Gestational sac 14 × 6 × 11 mm, with implantation on the cervix, with no sign of rupture, with Doppler flux, presence of an embryo	6,548	Methotrexate IM	Cervical Foley catheter

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[1] Address for correspondence Cássia Raquel Teatin Juliato, Rua Alexander Fleming, 101, Cidade Universitária Zeferino Vaz, Campinas, SP, 13083-881, Brazil (e-mail: cassia.raquel@gmail.com).