title: Local injection of diluted vasopressin followed by suction curettage for cervical ectopic pregnancy.
abstract: OBJECTIVE
  To report the results of local injection of diluted vasopressin followed by suction curettage as a conservative treatment for women with cervical ectopic pregnancy, who wish to preserve their future fertility.
  
  
  METHODS
  This was a retrospective chart review in a university hospital and a municipal hospital. We injected diluted vasopressin (Pitressin R, total amount of 4-10 units) transvaginally into the cervix surrounding the gestational sac, but not directly into the gestational sac, and/or the lower segment of the uterine body under transvaginal ultrasonographic guidance. After cessation of fetal heartbeats, we aspirated the conceptus by performing suction curettage. We injected additional vasopressin into the gestational sac in cases with a viable fetus after the initial injection. Forced contraction of the cervical smooth muscle facilitated removal of the conceptus with minimal blood loss during curettage. We measured operative time, total blood loss, complications, and the need for additional treatment.
  
  
  RESULTS
  We included 11 women. Mean patient age, gestational age, and serum human chorionic gonadotrophin (hCG) at the intervention were 31.2±6.4years, 6.0±0.6 weeks, and 18,370±21,570 IU/L, respectively. Mean size of the gestational sac was 19.6±9.5mm. The uterus was successfully preserved without any complications in all patients. All procedures were completed within 15min except for the first case (range: 5-33min). In 4 cases, the conceptus containing a gestational sac was spontaneously extruded en bloc from the external os after the injection. Additional systematic methotrexate administration was required in one case because of remaining villi at the implantation site with persistence of serum hCG levels after the procedure.
  
  
  CONCLUSIONS
  Local injection of diluted vasopressin and subsequent suction curettage is a feasible conservative treatment for cervical ectopic pregnancy.
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Japan. Electronic address: ishikawa@chiba-u.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishikawa
authors.affiliation: Department of Obstetrics and Gynecology, Matsudo City Hospital, Japan.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Unno
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Omoto
authors.affiliation: Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Japan.
authors.forename: Makio
authors.initials: M
authors.lastname: Shozu
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002584:Cervix Uteri; D006063:Chorionic Gonadotropin / Q000032:analysis; D003131:Combined Modality Therapy / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D006773:Hospitals, Municipal; D006785:Hospitals, University; D006801:Humans; D007273:Injections, Intramuscular; D007564:Japan; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D014619:Vacuum Curettage / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014667:Vasopressins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D006063:Chorionic Gonadotropin; D014662:Vasoconstrictor Agents; D014667:Vasopressins
keywords: Cervical ectopic pregnancy; Ectopic pregnancy; Suction curettage; Vasopressin