Successful management of a consecutive cervical pregnancy by sonographically guided transvaginal local injection: case report and review of the literature.
OBJECTIVE
The purpose of this study was to describe the successful management of a recurrent cervical pregnancy with local injection and to review similarly treated cases to determine adverse outcomes.


METHODS
A case of a recurrent cervical pregnancy treated with transvaginal local injection was reported. A MEDLINE English language search identified 90 cases of cervical pregnancy treated with local therapy. This literature was analyzed with regard to the various demographic and outcome variables described.


RESULTS
Successful use of the transvaginal local approach is described. A review of cases identified a mean maternal age of 33.6 years with a mean gestational age at diagnosis of 7.5 weeks. Bleeding was the most common presenting sign (79%). The mean beta-human chorionic gonadotropin level at the time of diagnosis was 27,798 IU with an average time to resolution of 7.5 weeks. The most common risk factor was a history of curettage (69%), followed by previous cesarean delivery (35%). An additional dose of methotrexate was needed in 6% of cases. Bleeding requiring alternate procedures was present in 5% of cases. There were no complications in 81% of cases. The need for transfusion and development of infection were seen in 3% of cases each. There was 1 case (1.1%) requiring hysterectomy, and no maternal deaths were reported.


CONCLUSIONS
Conservative management of cervical pregnancy using local injection has been reported to have a low complication rate and a high efficacy for cure.
Ferrara
Lauren
L
Department of Obstetrics, Gynecology, and Reproductive Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA. lauren.ferrara@mssm.edu
Belogolovkin
Victoria
V
Gandhi
Manisha
M
Litton
Christian
C
Jacobs
Adam
A
Saltzman
Daniel
D
Rebarber
Andrei
A
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000032:Abortion, Therapeutic; D000328:Adult; D000650:Amnion; D002584:Cervix Uteri; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008727:Methotrexate / Q000008:administration & dosage*; D011189:Potassium Chloride / Q000008:administration & dosage*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D018084:Ultrasonography, Interventional; D014592:Uterine Hemorrhage / Q000000981:diagnostic imaging
D000020:Abortifacient Agents, Nonsteroidal; D011189:Potassium Chloride; D008727:Methotrexate