Conservative management options for cervical pregnancy; case reports and literature review.
OBJECTIVE
To describe three cases of cervical pregnancy treated successfully with different conservative methods and review the literature on conservative treatment of cervical pregnancy over the last 30 years.


METHODS
Three patients treated conservatively for cervical pregnancy are reported. The literature regarding the conservative management of cervical pregnancy since 1965 was compiled using a MEDLINE search for articles published since 1980 and by reviewing the reference lists of published manuscripts.


RESULTS
Three cases of cervical pregnancy were successfully treated using methotrexate with leucovorin rescue, methotrexate without leucovorin rescue, and curettage after angiographic embolization of the right hypogastric and left uterine arteries. Review of conservatively managed cases of cervical pregnancy since 1965 indicates that medical management with methotrexate and preoperative angiographic embolization of the uterine blood supply, when appropriate, results in successful treatment without the need for transfusion.


CONCLUSIONS
Clinical suspicion of cervical pregnancy early in gestation with preoperative diagnosis may safely allow conservative treatment. Different clinical scenarios may preclude or limit which conservative management options are best for each case.
Department of Obstetrics, University of California, San Francisco, USA.
M D
MD
Creinin
V A
VA
Feldstein
D000328:Adult; D000792:Angiography; D000931:Antidotes / Q000627:therapeutic use*; D002584:Cervix Uteri; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000592:standards*; D005260:Female; D006801:Humans; D002955:Leucovorin / Q000627:therapeutic use*; D016239:MEDLINE; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016216:Ultrasonography, Prenatal; D014481:United States / Q000453:epidemiology; D014592:Uterine Hemorrhage / Q000517:prevention & control; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging
D000931:Antidotes; D002955:Leucovorin; D008727:Methotrexate