Cervical Ectopic Pregnancy: A Challenge

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[trx_image url=”http://imedi.mx/wp-content/uploads/2016/12/Ultra-3.jpg” link=”off” align=”left” shape=”square” increment=”yes”]Fortunately cervical pregnancy is the rarest form of ectopic pregnancy. The reports of their frequency are highly variable, ranging from one in 2,550 to one in 18,000 and other reports described one in 95,000 pregnancies. Cervical pregnancy is less than 1% of all ectopic
pregnancies [1- 5]. Some of the risk factors are: endometrial lesions due to previous cesarean scars, curettage or chronic infections, or the use of intrauterine devices, and more recently the use of techniques of assisted fertilization and embryo transfer [1-6].
Early diagnosis has helped to provide conservative management and reduce morbidity and mortality [3], otherwise the delay in the diagnosis will cause a hemodynamic compromise that may require hysterectomy by up to 50% of cases [6-8].
The diagnosis of cervical pregnancy may be provided by clinical data. In the early weeks of pregnancy, it is usually presented as transvaginal bleeding, resembling fresh blood and with a constant lower abdominal pain, not cramping, which is characteristic of threatened abortion.
During the physical examination it is usually found that the external cervix Os is closed and the cervix is enlarged and painful when moved. Nevertheless, this information is not specific [1,4,6]. The ultrasound, preferably endovaginal, is the resource that shows the characteristic findings of cervical pregnancy: the uterine cavity is empty with the gestational sac in the Os which dilate it and eventually
also to the inner hole of the cervical neck [1,2].
Furthermore, the use of Doppler color , enables the distinction between viable cervical ectopic pregnancy or abortion remains due to the difference of blood presence between them [4,6,7].
Kobayashi in 1969 established the criteria for cervical pregnancy: intrauterine echo-structures poorly demarcated or diffuse, enlarged
uterus, no intrauterine pregnancy and distended cervix [3-14].
Ushakov, meanwhile, established a classification of ultrasonographics criteria of cervical pregnancy [15].
1. Gestational sac in the endocervix.
2. Presence of an intact portion of the gestational sac between the channel and the internal cervical Os.
3. Invasion of trophoblastic tissue in the endocervix
4. Visualization of embryonic or fetal structures in ectopic gestational sac with cardiac activity.
5. Empty uterine cavity.
6. Endometrial Desidualizacion.
7. Hourglass-shaped uterus.
8. Presence of arterial flow in the peritrophoblastic tissue showed by Doppler color. Differential diagnoses include: incomplete abortion, complete or inevitable, cervical tumors, uterine tumors, degenerated cervical leiomyoma, trophoblastic tumor or placenta previa [9,16 20].
The diagnosis and treatment of this condition have changed significantly since 15 years ago. Early diagnosis is performed by vaginal ultrasonography during the treatment. We can say that there are reports about the use of methotrexate which has been used locally or
systemically [5], as well as flat bottom probes and cervix cerclage [10,12].
Other procedures are the embolization by angiography of the cervical arteries [11-14] or injection of methotrexate and potassium chloride sonographically guided [6,14,16] or cervix cerclage [8]. Thanks to these conservative treatments hysterectomy incidence of cervical pregnancy decreased from 89 to 21% in the last years.
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