Online ISSN (İngilizce)
Basılı ISSN (Türkçe)
Online ISSN (Türkçe)
Murat Yayla, Oluş Api
Cervical ectopic pregnancy: medical conservative management. Perinatoloji Dergisi 2015;23(3):S77 - S78 DOI: 10.2399/prn.15.S001084
Murat Aykut Özek, Gazi Üniversitesi Tıp Fakültesi, Ankara, email@example.com
Gönderilme Tarihi: 30 Ağustos 2015
Son Revizyon Tarihi: 30 Ağustos 2015
Kabul Edilme Tarihi: 01 Eylül 2015
Erken Baskı Tarihi: 01 Ekim 2015
Yayınlanma Tarihi: 01 Ekim 2015
Çıkar çakışması bulunmadığı belirtilmiştir.
Cervical ectopic pregnancy is a rare and dangerous condition. It comprises less than 1% of all ectopic pregnancies with an estimated incidence of 1 in 9000 deliveries. The condition by itself or medical and surgical interventions are associated with massive hemorrhage that could lead to significant morbidity and mortality. Risk factors thought to be associated with cervical ectopic pregnancy are pregnancies conceived thorough assisted reproductive technologies, previous uterine curettage and cesarean delivery. However, the pathophysiology and causes remain to be elucidated. The most common symptom of cervical pregnancy is vaginal bleeding (often painless). The pathologic, clinical and sonographic criteria for diagnosis of cervical pregnancy have been established. However, the diagnosis is more frequently made incidentally by first trimester sonogram or interventions for cases considered to be abortions. Since the experience is limited to case series, treatment of cervical pregnancy has not been clarified. There are wide variety of treatment modalities with different outcomes and complications. In terms of conservative treatment to be effective, early diagnosis is important. In their review; Hosni et al. (2014) stated, other than hemodynamic instability; serum b-hcg level above 10.000 mIU/mL, gestational age more than 9 weeks, presence of fetal heart beat and CRL greater than 10 mm as poor prognostic factors for primary methotrexate treatment. However, those criteria have not been established as those for tubal ectopic pregnancies. We are in the opinion that, patients’ compliance on the therapy is one of the most important aspects regarding conservative treatment options. High morbidity rates associated with surgical treatment modalities should be kept in mind. It was demonstrated that the rates of major hemorrhage and hysterectomy were 11 and 3% in the medically treated patients, respectively. The rate of major hemorrhage was 35% and of hysterectomy was 15% in the surgical treatment group. Methotrexate (MTX) treatment for cervical pregnancy was first reported by Farabow et al. (1983). For early cervical pregnancies without fetal cardiac activity, intramuscular multidose MTX is reported to be effective in most cases. On the other hand, there are reports which recommend intramuscular MTX (single dose or multidose) in conjunction with intraamniotic or intrafetal injection of potassium chloride (KCl) for more advanced cervical ectopic pregnancies with fetal cardiac activity. Whether combination of two conservative methods do increase effectiveness of treatment or hastens recovery has not been proven by randomized studies. Besides, intraamniotic injection of MTX or KCl carries risk of hemorrhage during the procedure. Our case has the risk factors that could lead failure of exclusive MTX treatment like gestational age, fetal cardiac activity, and high b-hCG level. Despite those conditions, option of medical conservative treatment was offered to our patient. Eventually, we avoided serious complications associated with surgical interventions and successfully managed the case. Considering the lack of established criteria and randomized studies, our experience could contribute to the literature in the context of avoiding complications associated with further interventions. We are in the opinion that there is need for further studies to delineate the conditions, indications and factors associated with failure of various treatment modalities.