Fertility-preserving Management of Cervical Ectopic Pregnancy in a Nigerian Teaching Hospital
Medical management of cervical ectopic pregnancy.
Cervical Ectopic Pregnancies (CEPs) are commonly associated with adverse outcomes due to diagnostic and treatment challenges. This report describes the successful management of an initially misdiagnosed CEP. A 30-year-old G4P2+1(Alive 2) presented to the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, with vaginal bleeding following 11 weeks amenorrhea. The patient was haemodynamically stable, with minimal bleeding per vaginam, and ultrasonography had previously diagnosed complete miscarriage. However, transvaginal ultrasonography demonstrated classical hour-glass uterus. The ballooned cervix contained a gestational sac and foetal node without cardiac activity. The patient was managed with a single dose of intramuscular methotrexate injection. Her serum B-HCG concentration declined from 460.8mIU/ml at presentation to <5mIU/ml on the 10th day post-methotrexate injection, with a complete clinical and ultrasonographic resolution of the features. A high index of suspicion and appropriate ultrasonographic skills are necessary for prompt diagnosis of a CEP. Medical management could minimise the risk of intractable haemorrhage and hysterectomy.
Prameela RC, Dev SV. Cervical ectopic pregnancy: 10-year experience at tertiary care hospital and current literature review. Int J Reprod Contracept Obstet Gynecol. 2016; 5: 734-742. http://dx.doi.org/10.18203/2320-1770.ijrcog20160575
Bukar M, Usman HA, Ibrahim SM, Numan AI. Cervical ectopic pregnancy patient treated with intramuscular methotrexate who subsequently had live birth: A case report and literature review. Trop J Obstet Gynaecol. 2019; 36: 465. https://doi.org/10.4103/TJOG.TJOG_46_19
Mouhajer M, Obed S, Okpala AM. Cervical ectopic pregnancy in resource-deprived areas: A rare and difficult diagnosis. Ghana Med J 2017; 51: 94-97. http://dx.doi.org/10.4314/gmj.v51i2.8
Parker VL, Srinivas M. Non-tubal ectopic pregnancy. Arch Gynecol Obstet 2016; 294: 19–27. https://doi.org/10.1007/s00404-016-4069-y
Timor-Tritsch IE, Monteagudo A, Bennett TA, Foley C, Ramos J, Agten AK. A new minimally invasive treatment for cesarean scar pregnancy and cervical pregnancy. Am J Obstet Gynecol 2016; 215: 351.e1-8. http://dx.doi.org/10.1016/j.ajog.2016.03.010
Rubin IC. Cervical pregnancy. Surg Gynecol Obstet. 1911; 13: 625-633. Available at https//ci.nii.ac.jp/naid/10015798645
Paalman RJ, McElin TW. Cervical pregnancy; review of the literature and presentation of cases. Am J Obstet Gynecol 1959; 77: 1261-1270. https://doi.org/10.1016/0002-9378(59)90366-7
Raskin MM. Diagnosis of cervical pregnancy by ultrasound: a case report. Am J Obstet Gynecol 1978; 130: 234-235. doi:10.1016/0002-9378(78)90377-0
Jurkovic D, Hacket E, Campbell S. Diagnosis and treatment of early cervical pregnancy: a review and a report of two cases treated conservatively. Ultrasound Obstet Gynecol 1996; 8: 373–380. https://doi.org/10.1046/j.1469-0705.1997.08060373.x
Zakaria MA, Abdallah ME, Shavell VI, Berman JM, Diamond MP, Kmak DC. Conservative management of cervical ectopic pregnancy: utility of uterine artery embolisation. Fertil Steril 2011; 95: 872–876. https://doi.org/10.1016/j.fertnstert.2010.12.024
Long Y, Zhu H, Hu Y, Shen L, Fu J, Huang W. Interventions for non-tubal ectopic pregnancy. Cochrane Database Syst Rev. 2020;7(7): CD011174. https://doi.org/10.1002/14651858.CD011174.pub2
Gun M, Mavrogiorgis M. Cervical ectopic pregnancy: a case report and literature review. Ultrasound Obstet Gynecol 2002; 19: 297-301. https://doi.org/10.1046/j.1469-0705.2002.00559.x
Hung T, Shau Y, Hsieh T, Hsu J, Soong YK, Jeng CJ. Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review. Hum Reprod 1998; 13: 2636-2642. https://doi.org/10.1093/humrep/13.9.2636
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