Volume 12, Issue 4 (5-2014)                   IJRM 2014, 12(4): 285-0 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Šijanović S, Vidosavljević D, Topolovec Z, Milostić-Srb A, Mrčela M. Management of cervical ectopic pregnancy after unsuccesful methotrexate treatment. IJRM. 2014; 12 (4) :285-0
URL: http://journals.ssu.ac.ir/ijrmnew/article-1-525-en.html
1- Cathedra for Gynaecology and Obstetrics, JJ. Strossmeyer University School of Medicine Osijek, Croatia
2- Cathedra for Gynaecology and Obstetrics, JJ. Strossmeyer University School of Medicine Osijek, Croatia , domagoj.vidosavljevic@gmail.com
3- Institute for pathology and forensic medicine, KBC Osijek, Osijek, Croatia
Abstract:   (867 Views)
Background: Cervical pregnancy is rare and dangerous form of ectopic pregnancy which can be treated surgically or conservatively. Methotrexate is reasonable conservative option with high efficiency and acceptable level of side effects. Aim of this paper is to present possible treatment option in case of methotrexate failure, still keeping the postulates of minimal invasive surgery.
Case:  We describe a case of cervical ectopic pregnancy in nulliparous female that was unsuccessfully treated with single dose, local, ultrasound guided intraamniotic methotrexate. Due to vaginal bleeding caused by remaining products of conception a hysteroscopic resection was performed.
Conclusion:  Despite the problems that can occur in methotrexate treatment, it is still by far, cheapest and most effective treatment of cervical pregnancies. If necessary, procedure can be combined with other minimal invasive surgical procedures leading to satisfactory results. Hysteroscopic resection has enabled us to remove the product of conception from cervix making the minimal damage to the local tissue, thus preserving fertility.
Full-Text [PDF 452 kb]   (241 Downloads) |   |   Full-Text (HTML)  (87 Views)  
Type of Study: Original Article |

1. Rubin IC. Cervical pregnancy. Am J Obstet Gynecol 1911; 13: 625-633.
2. Mitra AG, Harris-Owens M. Conservative medical management of advanced cervical ectopic pregnancies. Obst Gyecol Surv 2000; 55: 385-389. [DOI:10.1097/00006254-200006000-00024]
3. Monteagudo A, Minior VK,Stephenson C, Monda S, Timor-Tritsch IE. Non-surgical management of live ectopic pregnancy with ultrasound-guided local injection: a case series. Ultrasound Obstet Gynecol 2005; 25: 282-288. [DOI:10.1002/uog.1822]
4. Vela G, Tulandi T. Cervical pregnancy: The importance of early diagnosis and treatment. J Minim Invasive Gynecol 2007; 14: 481-484. [DOI:10.1016/j.jmig.2006.11.012]
5. Hofmann H, Urdl W, Hoffler H, Honigl W, Tamussino K. Cervical pregnancies: case reports and current concepts in diagnosis and treatment. Arch Gynecol Obstet 1987; 241; 63-69. [DOI:10.1007/BF00931444]
6. Yazici G, Aban M, Arslan M, Pata O, Oz U.Treatment of cervical viable pregnancy with a single intraamniotic methotrexate injection: a case report. Arch Gynecol Obstet 2004; 270: 61-63. [DOI:10.1007/s00404-002-0450-0]
7. Matteo M, Nappi L, Rosenberg P, Greco P. Combined medical-hysteroscopic conservative treatment of a viable pregnancy: A case report. J Minim Invasive Gynecol 2006; 13: 345-347. [DOI:10.1016/j.jmig.2006.03.009]
8. Kim JS, Nam KH, Kim TH, Lee HH, Lee KH. Hysteroscopic management of cervical pregnancy with intrauterine irrigation with H2O2. J Minim Invasive Gynecol 2008; 15: 627-630. [DOI:10.1016/j.jmig.2008.06.006]
9. Cepni I, Ocal P, Erkan S, Erzik B. Conservative treatment of cervical ectopic pregnancy with transvaginal ultrasound aspiration and single dose Methotrexate. Fertil Steril 2004; 81: 1130-1132. [DOI:10.1016/j.fertnstert.2003.09.052]
10. Hassiakos D, Bakas P, Creatsas G. Cervical pregnancy treated with transvaginal ultrasound-guided intra-amniotic instillation of metothrexate. Arch Gynecol Obstet 2005; 271: 69-72. [DOI:10.1007/s00404-003-0567-9]
11. Šijanović S, Vidosavljević D, Šijanović I. Methotrexate in local treatment of cervical heterotopic pregnancy with successful perinatal outcome: case report. J Obstet Gynaecol Res 2011; 37: 1241-1245. [DOI:10.1111/j.1447-0756.2010.01501.x]
12. Jeong EH, Kim YB, Ji IW. Triplet cervical pregnancy treated with intraamniotic methothrexate. Obstet Gynecol 2002; 100: 1117-1119.
13. Leeman L, Wendland C.Cervical Ectopic Pregnancy: Diagnosis With Endovaginal Ultrasound Examination and Successful Treatment With Methotrexate. Arch Fam Med 2000; 9: 72-77. [DOI:10.1001/archfami.9.1.72]
14. Hung Th, Jeng CJ, Yang YC, Wang KG, Lan CC. Treatment of cervical pregnancy with Metothrexate. Int J Gynecol Obstet 1996; 53: 243-247. [DOI:10.1016/0020-7292(96)02653-7]
15. Hulvert J, Mardešić T, Voboril J, Muller P. Heterotopic pregnancy and its occurrence in assisted reproduction. Ceska Gynekol 1999; 64: 299-301.
16. Grimbizis G, Chatzigeorgiou K, Tsalikis T, Athanasiadis A, Theodoridis T, Bontis JN. Evacuation of the cervix after methotrexate administration in the treatment of cervical pregnancy: five cases. Reprod Biomed Online 2006; 12: 487-492. [DOI:10.1016/S1472-6483(10)62003-2]
17. Tinelli A, Malvasi A, Vergara D, Casciaro S. Emergency surgical procedure for failed methotrexate treatment of cervical pregnancy: a case report. Eur J Contracept Reprod Health Care 2007; 12: 391-395. [DOI:10.1080/13625180701502351]
18. Fernandez H, Bourget P, Lelaidier C, Doumerc S, Frydman R. Methotrexate treatment of unilateral twin ectopic pregnancy: case report and pharmacokinetic considerations. Ultrasound Obstet Gynecol 1993; 3: 357-359. [DOI:10.1046/j.1469-0705.1993.03050357.x]
19. Moon HS, Hyun JH, Kim KS, Kim HJ, Moon SE, Koo JS. Use of Tuohy needle for intraamniotic methotrexate injection through the cervical canal in a cervical pregnancy after failure of systemic methotrexate treatment. Am J Obstet Gynecol 2010; 202: 4-6. [DOI:10.1016/j.ajog.2010.01.081]

Send email to the article author

© 2021 All Rights Reserved | International Journal of Reproductive BioMedicine

Designed & Developed by : Yektaweb