Cervical pregnancy successfully treated with a sequential combination of methotrexate and mifepristone

Sexton, Christopher; Sharp, Nicholas

doi:10.1111/j.0004-8666.2002.00095.x

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…Conservative management of early ectopic pregnancy, using medical treatment alone or in association with minimally invasive procedures, has been widely described as an effective strategy (Brand et al, 1993;Cerveira et al, 2005Cerveira et al, .e7, 2005Cerveira et al, .e10, 2008De Greef et al, 2005;Dotters et al, 1995;Gomez Garcia et al, 2012;Heikinheimo et al, 2004;Segna et al, 1990;Sexton and Sharp, 2002;Timor-Tritsch et al, 1994). Farabow et al (1983) were the first to describe the use of MTX for treatment of cervical pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review

Sardo

Alviggi

Zizolfi

et al. 2013

Reproductive BioMedicine Online

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Cervico-isthmic pregnancy is a rare form of ectopic pregnancy associated with a high morbidity and mortality rate. Recent advances in high-resolution ultrasound have made the diagnosis of early cervico-isthmic pregnancies easier. Early diagnosis allows a more conservative therapeutic approach that avoids hysterectomy and preserves fertility. Here is reported a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopic) methotrexate administration. The resectoscopic excision of the cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis. A literature review shows that no consensus exists for the treatment of cervico-isthmic pregnancies. We report a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopical) methotrexate administration. The resectoscopic excision of cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis.

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Section: Discussionmentioning

confidence: 99%

Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review

Sardo

Alviggi

Zizolfi

et al. 2013

Reproductive BioMedicine Online

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show abstract

“…Various techniques have been described. Systemic or local administration of methotrexate has been the most widely described medical treatment 2–6 , although the use of such a toxic agent with a concomitant intrauterine pregnancy should probably be avoided. The use of potassium chloride offers the opportunity to selectively terminate the cervical pregnancy while causing minimal disruption to the intrauterine pregnancy trophoblast 7 and was therefore used in this case.…”

Section: Discussionmentioning

confidence: 99%

Massive obstetric haemorrhage resulting from a conservatively managed cervical pregnancy at delivery of its twin

Olàh¹

2003

BJOG

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A 34 year old woman with a known twin pregnancy presented to the early pregnancy assessment unit at 12 weeks of gestation with vaginal bleeding. She had bilateral tubal occlusion as a consequence of severe peritonitis due to a ruptured appendix at the age of 12 and had conceived through in vitro fertilisation. Several earlier ultrasound scans had been reported as normal.On admission, the bleeding had settled and there was no evidence of any cardiodynamic compromise. The uterus felt to be appropriate for dates, and the cervix appeared closed. However, an ultrasound scan showed a heterotopic twin pregnancy, with one pregnancy implanted in the uterus, and the second pregnancy in the cervix (Fig. 1). The gravity of the situation was conveyed to the woman and her partner, and arrangements were made to perform selective feticide. Under a general anaesthetic and with transabdominal ultrasound guidance, the sac of the cervical pregnancy was aspirated and 3 mL of strong potassium chloride solution was injected into the fetus. The fetal heart ceased beating, and there was no significant haemorrhage. The patient remained in the hospital for a week, during which time there was a moderately heavy brownish vaginal loss.The brown discharge persisted throughout the pregnancy but monthly ultrasound confirmed the remaining fetus to be growing on the 50th centile with a fundal placenta. Steroids were administered at 24 weeks of gestation as a precautionary measure. At 34 weeks of gestation, the pregnancy appeared to be proceeding normally.At 36 weeks of gestation, the patient was admitted with a history of ruptured membranes. Clear amniotic fluid was draining from the cervix, although there was no uterine activity. The fetus was active, and the cardiotocograph was normal. Twenty-four hours later, it was decided to induce labour. The head was 3/5 palpable, and the cervix was soft, 1 cm long and 1 cm dilated with the forewaters intact. There was a palpable nodule or mass of about 1 cm diameter in the forewaters. When the forewaters were ruptured there was a 300 mL haemorrhage. The cardiotocograph remained normal initially, but the bleeding continued and later the cardiotocograph deteriorated with a reduction in variability and decelerations, so a decision was made to undertake a caesarean section.The baby weighed 2.6 kg and was delivered in good condition. The placenta appeared normal. The remains of the cervical pregnancy appeared as a brown mass in the cervical canal and were removed. Haemorrhage from the site of the cervical pregnancy was stemmed with sutures into the cervix, and the uterus was closed. However, on completing the operation, it was apparent that there was continuing haemorrhage from the cervix, and thus the abdomen was re-opened with a view to conducting a hysterectomy. The operation was difficult due to multiple adhesions from the uterus to the bowel and posterior wall of the pelvis. It was essential to remove the cervix as this was the site of haemorrhage. At the completion of the operation, the patient had devel...

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Cervical pregnancy successfully treated with a sequential combination of methotrexate and mifepristone

Cited by 2 publications

References 7 publications

Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review

Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review

Massive obstetric haemorrhage resulting from a conservatively managed cervical pregnancy at delivery of its twin

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