[Ectopic pregnancy management: cervical and abdominal pregnancies].
Cervical or abdominal pregnancies are rare forms of ectopic pregnancy and their management differs for different authors. Besides, the literature is mainly made of case-reports. The aim is to propose one or more management possibilities, keeping in mind that the level of proof obtained from the references used is insufficient to be affirmative. For cervical pregnancy, although hysterectomy is the reference treatment (especially in advanced pregnancy or hemorrhagic life-threatening forms), technical improvements in ultrasonography make feasible the diagnosis of non or weakly symptomatic forms, which could be treated conservatively in order to preserve fertility of these women. In this diagnostic situation the present treatment standard is methotrexate combined with intra-amniotic feticide in case of viable cervical pregnancy. Diagnosis of abdominal pregnancy is often made late. Treatment consists in laparotomy which enables better vascular control. Placental ablation remains as often as not dangerous and in most cases, it is better to abandon the attempt.
Riethmuller
D
D
Service de Gynécologie-Obstétrique, CHU Saint-Jacques, avenue du 8-Mai-1945, 25000 Besançon. didier.riethmuller@ufc-chu.univ-fcomte.fr
Courtois
L
L
Maillet
R
R
Schaal
J-P
JP
D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D002584:Cervix Uteri; D003131:Combined Modality Therapy; D005260:Female; D005298:Fertility; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011269:Pregnancy, Abdominal / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D014463:Ultrasonography
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate