title: Conservative Management of Cervical Ectopic Pregnancy.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of conservative management for cervical ectopic pregnancies.
  
  
  METHODS
  We conducted a retrospective review of all cases of cervical ectopic pregnancy diagnosed at our tertiary care academic centre between January 2002 and July 2014. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound according to published criteria. Management decisions were made by individual clinicians.
  
  
  RESULTS
  Cervical ectopic pregnancy was diagnosed in 27 women with a median age of 34 years. Two thirds of them were nulliparous, and 44% (12/27) reported infertility. The mean gestational age at diagnosis was seven weeks. The median serum human chorionic gonadotropin level was 11 300 IU/L (range 610 to 163 700). Fetal cardiac activity was present in 19 pregnancies (70%). Vaginal bleeding was the most common presentation, occurring in 23 cases (85%). Three women presented with acute life-threatening hemorrhage. All cases were successfully managed conservatively, allowing uterine preservation. Systemic methotrexate (single or multi-dose protocol) was the mainstay of therapy. Other minimally invasive interventions included ultrasound-guided injection of potassium chloride into the pregnancy, uterine artery embolization, vaginal ligation of cervical branches of the uterine arteries, and dilatation and curettage, with or without dilute vasopressin cervical infiltration and Foley catheter tamponade.
  
  
  CONCLUSIONS
  Systemic methotrexate alone or in combination with other minimally invasive techniques can be effective conservative treatment for cervical pregnancies. A fertility-sparing approach is the optimal treatment for this patient population, which has high rates of infertility and nulliparity. We present a management algorithm based on our results to aid in standardizing the management of cervical ectopic pregnancies.
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
authors.forename: Ally
authors.initials: A
authors.lastname: Murji
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Garbedian
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Thomas
authors.affiliation: Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON.
authors.forename: Barbara
authors.initials: B
authors.lastname: Cruickshank
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage; D000328:Adult; D002584:Cervix Uteri; D006063:Chorionic Gonadotropin / Q000097:blood; D003663:Decision Trees; D005260:Female; D005865:Gestational Age; D006801:Humans; D007273:Injections, Intramuscular; D008427:Maternal Health Services; D008727:Methotrexate / Q000008:administration & dosage; D009864:Ontario / Q000453:epidemiology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D006063:Chorionic Gonadotropin; D008727:Methotrexate
keywords: cervical ectopic pregnancy; conservative management; ectopic pregnancy; methotrexate; potassium chloride injection; uterine artery embolization