title: Cervico-isthmic pregnancy successfully treated with bipolar resection following methotrexate administration: case report and literature review.
abstract: Cervico-isthmic pregnancy is a rare form of ectopic pregnancy associated with a high morbidity and mortality rate. Recent advances in high-resolution ultrasound have made the diagnosis of early cervico-isthmic pregnancies easier. Early diagnosis allows a more conservative therapeutic approach that avoids hysterectomy and preserves fertility. Here is reported a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopic) methotrexate administration. The resectoscopic excision of the cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis. A literature review shows that no consensus exists for the treatment of cervico-isthmic pregnancies. We report a case of viable cervico-isthmic pregnancy successfully treated with resectoscopy after failed systemic and local (hysteroscopical) methotrexate administration. The resectoscopic excision of cervico-isthmic pregnancy was carried out with the technique of slicing, using a 27 bipolar resectoscope with a 4-mm loop. The procedure was successful with the complete removal of the ectopic pregnancy, while maintaining satisfactory haemostasis.
authors.affiliation: Department of Obstetrics and Gynaecology and Pathophisiology of Reproduction, University of Naples 'Federico II', Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Di Spiezio Sardo
authors.forename: Carlo
authors.initials: C
authors.lastname: Alviggi
authors.forename: Brunella
authors.initials: B
authors.lastname: Zizolfi
authors.forename: Marialuigia
authors.initials: M
authors.lastname: Spinelli
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Rosa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Placido
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use*; D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008727:Methotrexate / Q000627:therapeutic use*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate