Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy

García, Miriam; Benítez, Guadalupe Aguarón; Belda, Beatriz Barberá; Rodríguez, Carmen Callejón; Merlo, Gaspar González de

doi:10.1016/j.ejogrb.2012.06.024

Cited by 26 publications

(19 citation statements)

References 19 publications

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“…Treatment options for cervical pregnancy include MTX/mifepristone therapy, UAE, immediate curettage and even hysterectomy . The choice of treatment depends on vaginal bleeding, gestational age, initial serum β ‐hCG level, the presence of a fetal heartbeat and the patient's desire to preserve her fertility.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment options for cervical pregnancy include MTX/ mifepristone therapy, UAE, immediate curettage and even hysterectomy. [12][13][14] The choice of treatment depends on vaginal bleeding, gestational age, initial serum b-hCG level, the presence of a fetal heartbeat and the patient's desire to preserve her fertility. Advanced gestational age of the fetus frequently is associated with higher morbidity and greater risk of hysterectomy for patients with CP.…”

Section: Main Findingsmentioning

confidence: 99%

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Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Tao

Yin

et al. 2016

BJOG

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Objective The purpose of this retrospective study was to evaluate the safety and efficacy of uterine artery embolization (UAE) followed by curettage for conservative management of cervical pregnancy.Design Retrospective review.Setting Peking University First Hospital. Methods We retrospectively reviewed the clinical background and outcomes of patients with cervical pregnancy who underwent UAE followed by curettage for prevention of massive vaginal bleeding and removal of gestational tissue from the cervix. We also reviewed the literature on the role of UAE in the treatment of cervical pregnancy.Main outcome measures Clinical assessments included gestational age, gravidity, endocervical canal mass, serum beta-human chorionic gonadotrophin (b-HCG) level, blood loss, hospitalisation stay and expenses, time of resumption of menstruation and subsequent pregnancy outcomes.Results A total of 19 patients with cervical pregnancy treated with UAE followed by curettage were identified. Curettage was performed 24-72 hours after UAE in 16 patients, within 24 hours after UAE in three patients. None of the patients underwent a hysterectomy as a result of cervical pregnancy. Of the nine patients with available follow-up information (median follow-up time 59 months), eight resumed normal menstruation and one had a term pregnancy with a normal vaginal delivery. Quick regression of serum b-HCG level, low blood loss and short hospital stay were observed.Conclusion UAE combined with curettage is a safe, effective and fertility-sparing choice for treatment of patients with cervical pregnancy.

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Section: Discussionmentioning

confidence: 99%

Section: Main Findingsmentioning

confidence: 99%

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Tao

Yin

et al. 2016

BJOG

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“…Our literature search for studies describing the medical management of interstitial ectopic pregnancies between 1999 and 2012 (Table ) confirmed that no other published series involved the technique that we used. Previous reports showed that conservative management with systemic MTX, transvaginal MTX injected under US guidance, or hysteroscopic guidance, or combined systemic and local MTX therapy are effective and safe options.…”

Section: Discussionmentioning

confidence: 99%

“…Ectopic pregnancies most commonly arise within the isthmic or ampullar sections of the Fallopian tube . An interstitial pregnancy is rare (1–6% of all ectopic pregnancies) with a mortality of 2.5%, which is seven times higher than that of ectopic pregnancies in general …”

mentioning

confidence: 93%

Transabdominal ultrasound‐guided injection of methotrexate in the treatment of ectopic interstitial pregnancies

Framarino-dei-Malatesta

Piccioni

Derme

et al. 2014

J of Clinical Ultrasound

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“…Several case reports and literatures support surgical therapy alone or in combination with MTX and/or mifepristone rather than medical therapy alone for treatment of cervical pregnancy as the same as those of CSP [21,[32][33][34][35]. Uterine artery embolization for treatment and prevention of hemorrhage during curettage or evacuation is also effective to preserve the uterus [36][37][38][39].…”

Section: Management Of Cervical Pregnancymentioning

confidence: 99%

A Minimally Invasive Hemostatic Strategy for Cesarean Scar Pregnancy and Cervical Pregnancy

Takeda¹,

Takeda²,

Yorifuji³

et al. 2020

Non-Tubal Ectopic Pregnancy

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Cesarean scar pregnancy (CSP) and cervical pregnancy are categorized as non-tubal ectopic pregnancy, because these are associated with a high burden of maternal and fetal morbidity including early uterine rupture, prevalence of placenta previa accrete spectrum, massive hemorrhage, and hysterectomy. Although management methods vary according to the week of gestation, recent reviews and reports support an interventional or a combination of surgical and medical approaches for treatment of unruptured CSP and cervical pregnancy rather than medical approach alone. In cases of massive hemorrhage, pressure hemostasis using balloon tamponade should first be performed. If such hemostasis proves to be ineffective, surgical excision or transcatheter arterial embolization (TAE) should be selected next. TAE reportedly achieves a high hemostasis rate. However, complications such as subsequent endometrial hypoplasia, menstruation disorder, infertility, placenta accreta, and uterine rupture have been reported, even in cases that have undergone successful hemostasis with TAE using an absorbable embolus. Recently, a minimally invasive hemostatic strategy in obstetrics, which aims to preserve uterine function and enhance the safety of subsequent pregnancies, has been developed. Therefore, we should reconsider uterus-preserving hemostatic strategies for critical hemorrhage and management of non-tubal ectopic pregnancy under these circumstances by using safe and minimally invasive treatment modalities.

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Medical therapy (methotrexate and mifepristone) alone or in combination with another type of therapy for the management of cervical or interstitial ectopic pregnancy

Cited by 26 publications

References 19 publications

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Successful conservative treatment of cervical pregnancy with uterine artery embolization followed by curettage: a report of 19 cases

Transabdominal ultrasound‐guided injection of methotrexate in the treatment of ectopic interstitial pregnancies

A Minimally Invasive Hemostatic Strategy for Cesarean Scar Pregnancy and Cervical Pregnancy

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