Uterine Artery Embolization Along With the Administration of Methotrexate for Cervical Ectopic Pregnancy: Technical and Clinical Outcomes

Hirakawa, Masakazu; Tajima, Tsuyoshi; Yoshimitsu, Kengo; Irie, Hiroyuki; Ishigami, Kousei; Yahata, Hideaki; Wake, Norio; Honda, Hiroshi

doi:10.2214/ajr.08.1921

Cited by 52 publications

(41 citation statements)

References 22 publications

(22 reference statements)

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“…UAE is a known method in obstetrics and gynecology and in case of CP it is usually used in combination with MTX or dilatation and curettage [22,23], although there have been reports about successfully treating CP with UAE only [24,25].…”

Section: Discussionmentioning

confidence: 99%

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

Jukna¹,

Diržauskas²

2017

LietChirur

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BackgroundCervical pregnancy is a rare pathology with unclear etiology. This condition can be life-threatening and in certain situations be treated with total abdominal hysterectomy, although due to improving diagnostics, approach to cervical pregnancy's management has been changing towards fertility preserving treatment. Case report 38 years old patient with vaginal bleeding and lower abdomen pain was admitted to Klaipėda Seamen's hospital. After thorough evaluation, clinical diagnosis of cervical pregnancy was confirmed. Different approaches were considered and total abdominal hysterectomy was determined as most suitable method. Surgery was successful and post-operative period was uneventful. Discussion Ultrasonography is the main diagnostic tool used to observe cervical ectopic pregnancy. Speculum and bimanual examination usually show prominent findings, assisting cervical pregnancy's diagnose. Prior to improved diagnostic tools, total abdominal hysterectomy was the main approach treating cervical pregnancy. Now conservative management using methotrexate is considered as the first-line treatment and frequency of other fertility preserving procedures as suction curettage and tamponade or uterine artery embolization are increasing. Conclusion Data is limited because of cervical pregnancy's rarity and every case of this condition has to be assessed separately. Desire to preserve fertility and patient's condition must be taken to account before making decision on how cervical pregnancy will be managed. Key words: cervical pregnancy, ultrasonography, total hysterectomy 199 Cervical ectopic pregnancy: a case report and review of the literature Įvadas Nėštumas gimdos kaklelyje yra reta patologija, kurios tiksli etiologija nežinoma. Ši būklė gali būti gyvybiškai pavojinga ir gydoma totalia laparotomine histerektomija, tačiau tobulėjanti diagnostika leidžia ektopinį nėštumą gimdos kaklelyje gydyti išsaugant vaisingumą. Klinikinis atvejis 38 metų pacientė buvo paguldyta į Klaipėdos Jūrininkų ligoninę dėl kraujavimo iš makšties ir skausmo apatinėje pilvo dalyje. Nuodugniai ištyrus pacientę, buvo diagnozuotas nėštumas gimdos kaklelyje. Apsvarsčius skirtingas gydymo taktikas, totali laparotominė histerektomija buvo pasirinka kaip tinkamiausias gydymo būdas. Operacija buvo sėkminga, pooperacinis laikotarpis sklandus. Diskusija Ultragarso tyrimas yra pagrindinis nėštumo gimdos kaklelyje diagnostikos metodas. Skėtikliais ir bimanualinio tyrimo metu dažniausiai randami svarbūs pakitimai, kurie padeda pagrįsti diagnozę. Totali laparotominė histerektomija buvo pagrindinis gydymo metodas, tačiau tobulėjant diagnostikos metodams metotreksatas tapo pirmos eilės pasirinkimu kaklelinio nėštumo atveju. Kiti konservatyvūs gydymo metodai, pavyzdžiui, gimdos ir gimdos kaklelio abrazija, lydima tamponavimo Foley kateteriu, ar gimdos arterijos embolizacija, tampa vis populiaresni. Išvados Duomenys apie kaklelinį nėštumą yra riboti dėl šios patologijos retumo ir kiekvienas atvejis turi būti vertinamas individualiai. Noras išsaugoti vaising...

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Section: Discussionmentioning

confidence: 99%

Ektopinis nėštumas gimdos kaklelyje: klinikinis atvejis ir literatūros apžvalga

Jukna¹,

Diržauskas²

2017

LietChirur

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show abstract

“…The uterine bleeding is rare in heterotopic pregnancy. Also other syptoms are; abdominal pain 81.8%, adnexal mass 43.9%, peritoneal irritation 43.9% and enlarged uterus 42.4% were the classical clinical futures depending on the location of associated combined pregnancy (3) .…”

Section: Discussionmentioning

confidence: 99%

“…Medical conservative treatments include intraamniotic or cardiac injection of potassium chloride or metotrexate, intraamniotic injection of hypertonic solution (3,6) .…”

Section: Discussionmentioning

confidence: 99%

“…Conservative approaches can be used succesfully if up to 10 to 12 weeks of pregnancy was present because in advanced pregnancy trophoblastic tissue infiltrates deeply in to cervical wall (3) . If uncontrolled bleeding was started or if heterotopic pregnancy diagnosed at second or third trimester of pregnancy; radical treatment like hysterectomy was recommended.…”

Section: Discussionmentioning

confidence: 99%

“…The increasing incidence of ectopic pregnancies especially together with in vitro fertilisation mean that the increasing incidence of combined pregnancy as many as 2 in 15.000 live births (2) . Cervical heterotopic pregnancy represents a rare type of ectopic pregnancy, reported to be less than 0.1% of all pregnancies (3,4) . Pelvic inflammatory disease, use of an intrauterine device, ovulation induction and in vitro fertilisation has been related to the increased incidence of cervical pregnancy, but a direct relationship with heterotopic pregnancy has not been proved (5,6) .…”

Section: Introductionmentioning

confidence: 99%

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