A case of hysteroscopic resection of cervical pregnancy after successful treatment with systematic methotrexate

Masuda, H.; Endo, Toyohide; Yoshimasa, Yushi; Uchida, Hiroshi; Nakabayashi, Akira; Maruyama, Tetsuo; Tanaka, Mamoru

doi:10.1080/01443615.2016.1174837

Cited by 8 publications

(5 citation statements)

References 6 publications

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“…Patients who underwent small-caliber hysteroscopy in our case series did not receive MTX and were discharged the day after the procedure. Even though some authors report successful MTX treatment before hysteroscopic resection of CEP, 16,17 the length of hospital stay from these reports exceeds the number of days presented in our series. The findings of a shorter hospital stay along with minimal blood loss encountered during our procedure strengthens the cost-effectiveness and safety of small-caliber hysteroscopy in the treatment of CEP.…”

Section: Discussioncontrasting

confidence: 61%

Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy

Maglic

Rakic²,

Bonaci-Nikolic

et al. 2021

JSLS

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Background and Objectives: Cervical ectopic pregnancy is one of the rarest forms of ectopic pregnancy. We present a single center case series of 10 cases of cervical ectopic pregnancy, where 3 patients underwent small-caliber hysteroscopy as a single treatment method.Methods: This was a retrospective study of women treated at our medical center with the diagnosis of cervical ectopic pregnancy from January 1, 2018 to December 31, 2020. Patient characteristics, medical history, obstetric history, diagnostic methods were collected. Small-caliber hysteroscopy treatment was performed in 3 patients and 7 patients underwent dilation and curettage (D&C).Results: We identified 10 patients diagnosed with cervical ectopic pregnancy who were treated at our center. Ultrasonography was used to diagnose all cervical ectopic pregnancies Three patients underwent small-caliber hysteroscopy as a single treatment option, while D&C was performed in 7 patients. Patients who underwent small-caliber hysteroscopy had a median gestational age at diagnosis of 7 weeks and initial b HCG < 10,000 mIU/ mL. These patients had shorter hospital stay and a lower estimated blood loss than patients who underwent D&C. Conclusions:In our experience, small-caliber hysteroscopy is a safe and effective single treatment option for cervical ectopic pregnancy, but requires a skilled and experienced gynecologist.

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Section: Discussioncontrasting

confidence: 61%

Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy

Maglic

Rakic²,

Bonaci-Nikolic

et al. 2021

JSLS

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“…The complete trophoblast removal under direct visualization may prevent vaginal bleeding and it is followed by the rapid decline of the βhCG level. This mini-invasive surgical procedure, whose satisfactory response is testified by the βhCG trend, can reduces the hospitalization stay of the patient with an abatement of costs and a reduction in the time for the onset of a future pregnancy [ 16 ]. In two of our cases we decided firstly for a systemic medical management with MTX.…”

Section: Discussionmentioning

confidence: 99%

Ectopic Cervical Pregnancy: Treatment Route

et al. 2020

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Background and objectives: Cervical pregnancy (CP) is a rare form of ectopic pregnancy (EP) in which the embryo implants and grows inside the endocervical canal. Early diagnosis is essential in order to allow conservative medical and surgical treatments. Although many treatment approaches are disponible, the most effective is still unclear. The aim of this study is to evaluate the efficacy of hysteroscopic management in early CP in order to preserve future fertility. Materials and Methods: This is a retrospective observational case series. Five patients with a diagnosis of CP, hemodynamically stables and managed conservatively between 2014 and 2019 at the Institute of Child and Maternal Health Burlo Garofolo in Trieste, Italy, were included. Four patients, with βhCG levels > 5000 mUi/mL were managed by hysteroscopy, with or without a previous systemic Methotrexate (MTX). One case with βhCG levels < 5000 mUi/mL was treated using MTX combined to Mifepristone and Misoprostol. Results: In one patient treated by hysteroscopy alone it occurred a profuse vaginal bleeding with necessity for blood transfusion. Haemorrhage was controlled by a second hysteroscopic procedure. No complications, such as vaginal bleeding, were recorded in the other cases. Serum β-hCG levels become undetectable in a range of 15–40 days after hysteroscopic management; after medical treatment it become undetectable after 35 days. Serum βhCG levels had a faster drop the day after hysteroscopy than post medical management. The onset of a spontaneous pregnancy at the normal implantation site occurred after five months in one case treated by hysteroscopy. Conclusions: Many therapeutic approaches are effective for CP treatment. Hysteroscopy, alone or in combination with MTX, may provide a greater effect on the descent of βhCG, leading to a reduction of the hospitalization stay, decreasing costs and period for attempt pregnancy. Further prospective studies on larger samples are needed to define therapeutic protocols for CP management.

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“…There are several other treatments for CP [2,3,[9][10][11][12][13]. MTX has been systemically administrated for the treatment of CP [14]. However, a high level of HCG (>5000 mIU/ml) and/or the presence of a gestational sac with fetal cardiac activity are contraindications to the systemic use of MTX for CP management.…”

Section: Discussionmentioning

confidence: 99%

The treatment of cervical pregnancy with high-intensity focused ultrasound followed by suction curettage: report of three cases

Jiang

Xue

2019

International Journal of Hyperthermia

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Objective: Cervical pregnancy (CP) is a rare type of ectopic pregnancy and is considered to be a lifethreatening condition due to the risk of severe hemorrhage. Unfortunately, no consensus on standard conservative treatment for CP has been established. The study objective was to evaluate the efficacy and safety of high-intensity focused ultrasound (HIFU) followed by suction curettage for cervical pregnancy. Method: Three patients with cervical pregnancy undergoing high-intensity focused ultrasound followed by suction curettage were analyzed. Patient age, gestational age, endocervical mass, serum human chorionic gonadotrophin (HCG) level, blood loss, and time for normal menstruation recovery were recorded. Results: Three patients with cervical pregnancy were successfully treated with HIFU followed by suction curettage. After HIFU treatment, the fetal cardiac activity disappeared or the blood flow in the pregnancy tissue significantly decreased. The termination of the cervical pregnancy of all three patients was performed successfully without heavy bleeding. The estimated blood loss was 10-20 ml. The time for menstruation recovery was 30-45 days. No obvious complications of HIFU were observed in these cases. Conclusion: High-intensity focused ultrasound followed by suction curettage seems to be considered as conservative management for patients who desire to preserve their uterus.

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A case of hysteroscopic resection of cervical pregnancy after successful treatment with systematic methotrexate

Cited by 8 publications

References 6 publications

Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy

Management of Cervical Ectopic Pregnancy with Small-Caliber Hysteroscopy

Ectopic Cervical Pregnancy: Treatment Route

The treatment of cervical pregnancy with high-intensity focused ultrasound followed by suction curettage: report of three cases

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