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Recently, various conservative regimens for the treatment of cervical pregnancy have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used drugs. The success of conservative treatment depends on early preoperative diagnosis. We report three cases of first trimester cervical pregnancy, successfully treated by curettage to evacuate the conceptus, followed by local prostaglandin instillation to prevent severe haemorrhage. In one patient, intra-amniotic instillation of hyperosmolar glucose was necessary to terminate fetal cardiac activity. beta-Human chorionic gonadotrophin returned to normal within 3 weeks in one patient and within 7 weeks in another, both of whom became pregnant again within 1 year, resulting in term deliveries. The third patient was lost to follow-up after 1 week. The advantage of prostaglandin and curettage is the absence of major side-effects to the mother or the fetus of a subsequent pregnancy. The management strategies used in the treatment of cervical pregnancies and the results obtained since the introduction of methotrexate in 1989 are discussed in the context of previously published literature. The incidence of subsequent pregnancies among women treated medically versus women treated surgically is reported.

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Study DesignComprehensive literature review.PurposeTo document the criteria for fusion utilized in these studies to determine if a consensus on the definition of a solid fusion exists.Overview of LiteratureNumerous studies have reported on fusion rates following anterior cervical arthrodesis. There is a wide discrepancy in the fusion rates in these studies. While factors such as graft type, Instrumentation, and technique play a factor in fusion rate, another reason for the difference may be a result of differences in the definition of fusion following anterior cervical spine surgery.MethodsA comprehensive English Medline literature review from 1966 to 2004 using the key words "anterior," "cervical," and "fusion" was performed. We divided these into two groups: newer studies done between 2000 and 2004, and earlier studies done between 1966 and 2000. These articles were then analyzed for the number of patients, follow-up period, graft type, and levels fused. Moreover, all of the articles were examined for their definition of fusion along with their fusion rate.ResultsIn the earlier studies from 1966 to 2000, there was no consensus for what constituted a solid fusion. Only fifteen percent of these studies employed the most stringent definition of a solid fusion which was the presence of bridging bone and the absence of motion on flexion and extension radiographs. On the other hand, the later studies (2000 to 2004) used such a definition a majority (63%) of the time, suggesting that a consensus opinion for the definition of fusion is beginning to form.ConclusionsOur study suggests that over the past several years, a consensus definition of fusion is beginning to form. However, a large percentage of studies are still being published without using stringent fusion criteria. To that end, we recommend that all studies reporting on fusion rates use the most stringent criteria for solid fusion following anterior cervical spine surgery: the absence of motion on flexion/extension views and presence of bridging trabeculae on lateral x-rays. We believe that a universal adoption of such uniform criteria will help to standardize such studies and make it more possible to compare one study with another.