Conservative management of cervical pregnancy: a report of two cases.
BACKGROUND
Cervical ectopic pregnancy is a rare form of ectopic pregnancy. Treatment of this clinical condition is controversial. Previously, hysterectomy was the mainstay of treatment, but in the recent past various conservative management approaches have been applied to preserve fertility. We report 2 such cases in which conservative approach was implemented.


METHODS
Case 1 was an early, nonviable cervical pregnancy in which systemic methotrexate was used with success. Case 2 was a viable, advanced cervical pregnancy (at 11 weeks) in which a combination of uterine artery embolization and systemic methotrexate was used. Ultimately this patient required hysterectomy due to sudden massive hemorrhage on day 22 of intervention.


CONCLUSIONS
On reviewing our results and the literature, we conclude that uterine artery embolization with methotrexate is effective in reducing the ectopic cervical mass. However, there is always a risk of hemorrhage, which can be treated by either repeat uterine artery embolization alone or uterine artery embolization followed by curettage. Hysterectomy should be the last resort if all conservative methods fail.
Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110002, India. dr_vidh@yahoo.co.in
Vidhi
V
Chaudhary
Poonam
P
Sachdeva
Devender
D
Kumar
Raksha
R
Arora
Jyoti
J
Banavaliker
Muntaha
M
Khan
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D008727:Methotrexate / Q000008:administration & dosage; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000000981:diagnostic imaging / Q000628:therapy*; D014463:Ultrasonography; D055988:Uterine Artery; D014592:Uterine Hemorrhage / Q000601:surgery
D000020:Abortifacient Agents, Nonsteroidal; D008727:Methotrexate